rifampin and Scalp-Dermatoses

Topics: Aged; Anti-Bacterial Agents; Blister; Clobetasol; Drug Therapy, Combination; Epidermolysis Bullosa; Fusidic Acid; Glucocorticoids; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Periodontal Diseases; Photosensitivity Disorders; Rifampin; Scalp Dermatoses; 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

Buruli ulcer (BU) denotes a cutaneous infection by Mycobacterium ulcerans endemic in certain tropical and subtropical regions. Treatment may be either medical and surgical or else purely medical for early lesions. The literature contains reports of several cases of transient aggravation of BU following initiation of medical treatment. We report a case observed in the Ivory Coast, one of the areas with the highest prevalence of BU worldwide. The distinguishing features of our case are the early onset of this paradoxical reaction and the multiple cephalic site of lesions.. A 4-year-old child with no prior medical history was referred for two painless ulcerative cutaneous nodules. Incubation of samples from the edges of these lesions revealed the presence of acid-alcohol resistant bacilli (AARB), which were shown by PCR to be M. ulcerans, the causative agent in BU. Treatment consisted of levofloxacin (100mg/d) and rifampicin (150mg/d) for 8weeks. After 7days of medical treatment, seven painless nodules appeared on the patient's scalp. Further PCR for these lesions confirmed the presence of M. ulcerans. The same medical therapy was maintained and after 54days of treatment, all lesions had been healed.. The originality of this case rests on two features: the bifocal aspect of the lesions, which is uncommon, and the early development of cephalic predominance that occurred after the start of drug treatment. While cases of lesions secondary to initiation of medical therapy have already been described, such lesions generally occurred after at least 2months of treatment and did not involve the head.

Topics: Anti-Bacterial Agents; Buruli Ulcer; Child, Preschool; Chin; Cicatrix; Cote d'Ivoire; Drug Therapy, Combination; Endemic Diseases; Facial Dermatoses; Female; Humans; Leg; Levofloxacin; Mycobacterium ulcerans; Ofloxacin; Rifampin; Scalp Dermatoses; Time Factors

Dissecting cellulitis of the scalp, or perifolliculitis capitis abscedens et suffodiens, is an uncommon chronic suppurative disease of the scalp manifested by follicular and perifollicular inflammatory nodules that suppurate and undermine, forming intercommunicating sinuses, and leading to scarring alopecia. Treatment generally fails to obtain a permanently successful result; thus, many therapeutic options have been proposed. We report 4 cases of dissecting cellulitis of the scalp successfully treated with oral rifampicin and oral isotretinoin. To our knowledge, this is the first report of oral rifampicin used concomitantly with oral isotretinoin in this disease entity. We also present a brief review of the literature on the topic.

Topics: Administration, Oral; Adult; Cellulitis; Dermatologic Agents; Diagnosis, Differential; Drug Therapy, Combination; Enzyme Inhibitors; Humans; Isotretinoin; Male; Rifampin; Scalp Dermatoses

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

A 32 year-old woman developed generalised lichenoid eruptions on her body followed by diffuse loss of scalp hair of the anagen effluvium type. She was receiving several anti-tubercular drugs, including rifampicin, isonicotinic acid hydrazide (INH), pyrazinamide, and ethambutol, for abdominal tuberculosis. INH, which is a leading cause of drug eruptions in the above group of drugs was withdrawn. However, the other antitubercular drugs were continued along with 40 mg of prednisolone in a single daily morning dose. The latter was discontinued slowly over a period of 10 weeks. There was complete recovery of hair loss and the regrowth started after 12 weeks of alopecia. Such anagen effluvium with lichenoid eruption following INH therapy has not been observed previously. The complete recovery from anagen effluvium is difficult to explain, but it could have been because of the early initiation of corticosteroid.

Topics: Adult; Alopecia; Antitubercular Agents; Ethambutol; Female; Humans; Isoniazid; Lichenoid Eruptions; Pyrazinamide; Rifampin; Scalp Dermatoses; Tuberculosis, Gastrointestinal

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

A cluster of toxic reactions among children inadvertently given excessive doses of rifampin for chemoprophylaxis of invasive Haemophilus influenzae disease in a day-care center was investigated. In all 19 children, who received five times the therapeutic dose of rifampin, dramatic adverse reactions developed. A striking, "glowing" red discoloration of the skin and facial or periorbital edema were found to be the hallmarks of rifampin toxicity. These clinical signs of acute toxicity contrast sharply with the adverse side effects of rifampin reported with therapeutic doses.

Topics: Acute Disease; Child Day Care Centers; Child, Preschool; Edema; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Medication Errors; Pigmentation Disorders; Rifampin; Scalp Dermatoses; Skin Diseases; Vomiting