tretinoin and Scalp-Dermatoses

Dissecting cellulitis (DC) also referred to as to as perifolliculitis capitis abscedens et suffodiens (Hoffman) manifests with perifollicular pustules, nodules, abscesses and sinuses that evolve into scarring alopecia. In the U.S., it predominantly occurs in African American men between 20-40 years of age. DC also occurs in other races and women more rarely. DC has been reported worldwide. Older therapies reported effective include: low dose oral zinc, isotretinoin, minocycline, sulfa drugs, tetracycline, prednisone, intralesional triamcinolone, incision and drainage, dapsone, antiandrogens (in women), topical clindamycin, topical isotretinoin, X-ray epilation and ablation, ablative C02 lasers, hair removal lasers (800nm and 694nm), and surgical excision. Newer treatments reported include tumor necrosis factor blockers (TNFB), quinolones, macrolide antibiotics, rifampin, alitretinoin, metronidazole, and high dose zinc sulphate (135-220 mg TID). Isotretinoin seems to provide the best chance at remission, but the number of reports is small, dosing schedules variable, and the long term follow up beyond a year is negligible; treatment failures have been reported. TNFB can succeed when isotretinoin fails, either as monotherapy, or as a bridge to aggressive surgical treatment, but long term data is lacking. Non-medical therapies noted in the last decade include: the 1064 nm laser, ALA-PDT, and modern external beam radiation therapy. Studies that span more than 1 year are lacking. Newer pathologic hair findings include: pigmented casts, black dots, and "3D" yellow dots. Newer associations include: keratitis-ichthyosis-deafness syndrome, Crohn disease and pyoderma gangrenosum. Older associations include arthritis and keratitis. DC is likely a reaction pattern, as is shown by its varied therapeutic successes and failures. The etiology of DC remains enigmatic and DC is distinct from hidradenitis suppurativa, which is shown by their varied responses to therapies and their histologic differences. Like HS, DC likely involves both follicular dysfunction and an aberrant cutaneous immune response to commensal bacteria, such as coagulase negative staphylococci. The incidence of DC is likely under-reported. The literature suggests that now most cases of DC can be treated effectively. However, the lack of clinical studies regarding DC prevents full understanding of the disease and limits the ability to define a consensus treatment algorithm.

Topics: Acitretin; Alitretinoin; Anti-Bacterial Agents; Cellulitis; Dermatologic Agents; Diagnosis, Differential; Estrogens; Ethinyl Estradiol; Hidradenitis Suppurativa; History, 20th Century; Humans; Laser Therapy; Lymphotoxin-alpha; Phototherapy; Radiotherapy; Scalp Dermatoses; Skin Diseases, Genetic; Tretinoin; Zinc

Topics: Acitretin; Angiolymphoid Hyperplasia with Eosinophilia; Female; Humans; Middle Aged; Remission Induction; Scalp Dermatoses; Tretinoin

In a double-blind, cross-over trial with Tigason and placebo, the parameters of palmoplantar pustulosis underwent significant changes during the retinoid therapy. A hand-over effect was clearly indicated during the placebo period and several patients experienced long-lasting remissions.

Topics: Adult; Aged; Clinical Trials as Topic; Dermatologic Agents; Double-Blind Method; Etretinate; Female; Foot Dermatoses; Hand Dermatoses; Humans; Middle Aged; PUVA Therapy; Scalp Dermatoses; Suppuration; Tretinoin

Topics: Alopecia; Antirheumatic Agents; Biopsy; Diagnosis, Differential; Drug Administration Routes; Humans; Hydroxychloroquine; Keratolytic Agents; Lupus Erythematosus, Discoid; Male; Middle Aged; Scalp Dermatoses; Skin; Treatment Outcome; Tretinoin

We report the case of a 24-year-old man who presented with pustules, atrophic scars, and alopecia on the scalp, along with follicular keratotic papules on the cheeks, chest, abdomen, back, lateral upper arms, thighs, and axillae, of 6 years' duration. A diagnosis of folliculitis spinulosa decalvans (FSD) was made based on the clinical manifestation and histopathological findings. Dental examination also revealed dental anomalies and a fissured tongue, which are not known to be related to FSD. We provide an overview of the characteristic findings of FSD as well as a review of previously reported cases.

Topics: Adult; Alopecia; Anti-Infective Agents; Clarithromycin; Dermatologic Agents; Diagnosis, Differential; Folliculitis; Fusidic Acid; Humans; Keratosis; Male; Metronidazole; Scalp; Scalp Dermatoses; Skin; Treatment Outcome; Tretinoin

Topics: Adolescent; Alitretinoin; Biopsy; Cellulitis; Deafness; Dermatologic Agents; Humans; Ichthyosis; Keratitis; Male; Scalp Dermatoses; Skin; Skin Diseases, Genetic; Treatment Outcome; Tretinoin

A 62-year-old man presented with slowly progredient, centrifugal, peripherally hyperkeratotic, centrally atrophic, slightly pruritic lesions on his scalp for at least 9 months. A punch biopsy stained with hematoxylin-eosin (HE) revealed minimal epidermal acanthosis and chimney-like parakeratosis (cornoid lamella) around a follicle. Discrete spongiosis of the epidermis was observed, as well as a lymphocytic cell infiltration in the papillary dermis. Based on the clinical picture and the histopathological examination the diagnosis of porokeratosis of Mibelli was made. Topical treatment was started using an urea and vitamin A acid preparation.

Topics: Administration, Topical; Biopsy; Chromosome Aberrations; Diagnosis, Differential; Drug Combinations; Humans; Keratolytic Agents; Male; Middle Aged; Porokeratosis; Prognosis; Scalp; Scalp Dermatoses; Tretinoin; Urea

Perifolliculitis capitis abscedens et suffodiens (PCAS) is rare chronic, suppurative and inflammatory scalp disease. Its aetiology and pathogenesis is not completely understood. The treatment is usually difficult and often disappointing. We report a case of 29-year-old male who presented with tender, fluctuant nodules and abscesses, with draining pus and patchy alopecia on his scalp for 3 years. A skin biopsy from scalp lesions revealed features that are characteristic of perifolliculitis. Initially, the patient was treated with periodic incision and drainage of the scalp abscesses. The answer was very poor. When admitted to our department, isotretinoin was started at daily dose of 30 mg, because initially his cholesterol and triglyceride levels were mildly increased. When dose was reduced to 10 mg the levels of cholesterol and triglyceride remained normal. A response to treatment was excellent and rapid. The treatment of PCAS represents usually difficulties and frustration for both the patient and the physician. A long course of isotretinoin can be considered as one of the most effective treatment for PCAS.

Topics: Administration, Topical; Adult; Alopecia; Folliculitis; Humans; Keratolytic Agents; Male; Scalp Dermatoses; Tretinoin

Topics: Drug Eruptions; Erythema; Granuloma; Humans; Male; Middle Aged; Minoxidil; Scalp Dermatoses; Tretinoin

Topics: Adult; Cellulitis; Humans; Isotretinoin; Male; Scalp Dermatoses; Tretinoin

Topics: Adult; Folliculitis; Humans; Isotretinoin; Male; Scalp Dermatoses; Tretinoin