Original article
Folliculitis decalvans: Effectiveness of therapies and prognostic factors in a multicenter series of 60 patients with long-term follow-up

https://doi.org/10.1016/j.jaad.2018.05.1240Get rights and content

Background

Folliculitis decalvans (FD) is a rare neutrophilic cicatricial alopecia that poses a therapeutic challenge.

Objectives

To describe the therapeutic response in a large number of cases of FD with long-term follow-up and analyze potential prognostic factors associated with severity of form and with a better therapeutic response.

Methods

This multicenter prospective study included patients with FD who had a minimum of 5 years of follow-up. Severity was assessed by the maximum diameter of the cicatricial area. Therapeutic response was evaluated according to stabilization of the size of the cicatricial areas and the improvement in clinical symptoms.

Results

A total of 60 patients (37 men [61.7%] and 23 women [38.3%]) with a mean age of 40 years were included. Earlier age of onset (P = .01) was statistically associated with severity of form. Treatment with rifampicin and clindamycin, tetracyclines, and intralesional steroids was the most effective. No statistically significant prognostic factors predicting a better therapeutic response were found.

Limitations

Because FD is a rare disease, the main limitation was the sample size.

Conclusions

An earlier age of onset was associated with the severe form of the disease. The proposed specific therapeutic protocol can be a very useful tool in clinical dermatologic practice.

Section snippets

Study design

A retrospective multicenter study was designed; it included patients with FD and a minimum follow-up period of 5 years. The study included patients evaluated in 9 Spanish medical centers between 1995 and 2015. The diagnosis of FD was confirmed by histopathology in all patients. The following details of all patients were recorded in a database: epidemiologic (sex, age, race, comorbidities, family history, and associated trigger), clinical (age of onset, size, affected areas, symptoms, signs, and

Results

A total of 60 patients (37 males [61.7%] and 23 females [38.3%]) with a median age of 40 years (range, 23-83) were included in the study. Fifty-eight patients (96.6%) were white, 1 (1.6%) was Hispanic, and 1 (1.6%) was of African origin.

The associated comorbidities were as follows: hypercholesterolemia in 8 patients (13.3%), arterial hypertension in 7 patients (11%), pollen allergy in 3 patients (5%), obesity in 2 patients (3.3%), and non-Hodgkin lymphoma in 1 patient (1.6%). There were no

Discussion

Our study was based on patients with FD and a follow-up period of more than 5 years, and it was intended to deepen the knowledge of this disease. We have proposed a specific therapeutic protocol that could be very useful in the daily practice of the dermatologist (Table I).1, 2, 7, 8, 9

FD affects young patients, with a discrete male predominance.2, 6, 8, 9, 12, 13, 14, 15 In our study, the detected comorbidities and laboratory tests performed reflect the fact that the disease has no association

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Funding sources: None.

Conflicts of interest: None disclosed.

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