rifampin and Folliculitis

Topics: Adult; Aged; Anti-Bacterial Agents; Clarithromycin; Drug Therapy, Combination; Female; Folliculitis; Fusidic Acid; Humans; Male; Propionibacterium acnes; Remission Induction; Retrospective Studies; Rifampin; Scalp; Staphylococcus aureus; Treatment Outcome

Folliculitis decalvans leads to scarring alopecia through inflammatory destruction of the hair follicle. Currently, antibiotics are most commonly used to treat this disease. However, treatment regimens with antibiotics feature a high relapse rate and encourage the development of resistant bacteria.. To evaluate the outcome of different treatment options for folliculitis decalvans.. Retrospective study to compare the efficacy of different treatment regimens in 28 patients with folliculitis decalvans.. The success of treatment with clindamycin and rifampicin, clarithromycin, dapsone and isotretinoin was analysed. The evaluation of the combination of clindamycin and rifampicin showed the lowest success rate in achieving long-term remission, since 80% of the patients relapsed shortly after end of treatment. Clarithromycin and dapsone were more successful with long-term and stable remission rates of 33% and 43% respectively. Treatment with isotretinoin was the most successful oral treatment in our analysis with 90% of the patients experiencing stable remission during and up to two years after cessation of the treatment.. The common use of antibiotics as first-line therapy in folliculitis decalvans needs to be re-evaluated critically and oral isotretinoin should be considered as valid treatment alternative.

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Clindamycin; Dermatologic Agents; Drug Therapy, Combination; Female; Folliculitis; Follow-Up Studies; Humans; Isotretinoin; Male; Middle Aged; Retrospective Studies; Rifampin; Scalp Dermatoses; Treatment Outcome; Young Adult

A 47-year-old woman presented with erythematous lesions with papules and pustules on her parieto-occipital region that had been present for 8 months. Areas of sclero-atrophic alopecia were evident, whereas at different points tufted hair shafts were coming out from single dilatated follicular ostia. Before our observation, an antibiotic oral therapy with tetracyclines and local with erythromycin had been administered to the patient, with partial improvement and relapse on its suspension.. Bacterial culture from pustules showed the development of Staphylococcus aureus. A skin biopsy was done. According to clinical and histopathological findings a diagnosis of tufted hair folliculitis was made and a treatment with oral rifampicin was started at the dosage of 450 mg twice per day.. After 3 weeks of therapy, the pustular lesions regressed completely and after a follow-up of 1 year no relapse was observed.. Rifampicin is one of the best active antibiotics against S. aureus, which seems to play a role in the pathogenesis of tufted hair folliculitis. Our results, if further confirmed, may suggest a role for rifampicin either for the control of the pustular phase of this rare disorder or to prevent its relapses for a long time.

Topics: Anti-Bacterial Agents; Female; Folliculitis; Humans; Middle Aged; Rifampin; Scalp Dermatoses; Staphylococcal Skin Infections

A 35-year-old man developed red papules and plaques with alopecia and hair tufts on the parietal and occipital areas of his scalp. Each tuft was comprised of 5 to 25 hairs arising from individual hair follicules. Histopathological findings showed a dense infiltration of plasma cells in the dermis. Based on these findings, he was diagnosed as tufted hair folliculitis. Oral minocycline and topical gentamicin were not effective, but the patient responded well to four weeks of oral refampicin.

Topics: Administration, Oral; Adult; Biopsy, Needle; Folliculitis; Follow-Up Studies; Hair Diseases; Humans; Immunohistochemistry; Male; Rifampin; Scalp Dermatoses; Treatment Outcome

Topics: Administration, Oral; Administration, Topical; Adult; Anti-Bacterial Agents; Drug Therapy, Combination; Folliculitis; Humans; Male; Mupirocin; Rifampin; Scalp Dermatoses

Topics: Clindamycin; Drug Therapy, Combination; Folliculitis; Humans; Rifampin

Topics: Adult; Aged; Clindamycin; Drug Therapy, Combination; Female; Folliculitis; Humans; Male; Middle Aged; Rifampin; Staphylococcal Infections; Staphylococcus aureus

In a series of 18 patients with folliculitis decalvans attending the Oxford hair clinic, eight were found to have areas of tufted folliculitis either at presentation or follow-up. There was no difference between these two groups in their presentation, clinical course, growth of causative organism (Staphylococcus aureus) or investigations including histology. We suggest that these two entities form part of a spectrum of a single disease. We performed lymphocyte staining on affected scalp biopsies, including CD4: CD8 and T-cell/B-cell ratios, but found no evidence of local immune suppression or failure which would explain the abnormal host response to a common pathogen in this rare condition. We introduced a new treatment regimen for these patients, oral rifampicin and oral clindamycin together for 10 weeks. Ten of the 18 patients have responded well with no evidence of recurrence 2-22 months after one course of treatment, and 15 of the 18 responded after two or three courses.

Topics: Adolescent; Adult; Clindamycin; Drug Therapy, Combination; Female; Folliculitis; Humans; Immunohistochemistry; Immunophenotyping; Male; Middle Aged; Rifampin; Scalp; Scalp Dermatoses

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Chlortetracycline; Drug Resistance, Microbial; Folliculitis; Health Personnel; Humans; Male; Methicillin; Middle Aged; Penicillins; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Folliculitis decalvans is a rare follicular inflammatory disease of the scalp. It is characterized by initial perifollicular inflammatory changes followed by peripheral extension and eventual circumscribed patches of cicatricial alopecia. The disease is known for its resistance to treatment, resulting in an unfavorable prognosis. The cause of the disease is unknown, although a bacterial etiology is postulated. We report a classic case that was temporized with various antibiotics and only subsequently resolved after ten weeks of therapy with rifampin. The patient has remained free of disease for more than one year. We present a brief review of the cicatricial alopecias and discuss rifampin therapy for this condition.

Topics: Adult; Alopecia; Cicatrix; Female; Folliculitis; Humans; Rifampin