Folliculitis decalvans. Possibilities of combined therapy with 308 nm UVB: clinical cases

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Abstract

Folliculitis decalvans is a rare neutrophilic cicatricial alopecia of the scalp. As it is a progressive inflammatory disease characterized by a gradual increase in the area of inflamed follicles with the formation of areas of cicatricial alopecia in the outcome. The most common clinical manifestations of folliculitis decalvans are follicular pustules, polytrichia, erosions and hemorrhagic crusts. At later stages dermal fibrosis predominates. The exact cause of folliculitis decalvans is not fully understood, but it is believed that Staphylococcus aureus may play a role in its development. Current knowledge regarding the pathogenesis of folliculitis decalvans suggests three stages including hyperactivation of innate immunity, bacterial infection and fibrosis as an outcome of the disease. The most frequently used treatments are topical steroids, topical antibiotics, and systemic antibacterial drugs, systemic isotretinoin, topical anti-inflammatory drugs, genetically engineered biological drugs, laser and surgical treatment, but all of the above methods usually result in only temporary remission. Phototherapy is an efficient therapy for a variety of skin diseases. We hypothesize that wavelengths in a range 308 nm eradicate bacteria more effectively than antibiotics in monotherapy. The combination of ultraviolet-B 308 nm, oral antibiotics, topical combined glucocorticoid drugs, topical and systemic application of bacteriophages, sensitives to the identified flora to the drugs have demonstrated an excellent tolerance and great outcomes in a series of cases.

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About the authors

Anna V. Gurovich

Moscow Regional Research and Clinical Institute

Author for correspondence.
Email: gu_anna@mail.ru
ORCID iD: 0000-0001-6068-5425
SPIN-code: 5330-8172
Russian Federation, Moscow

Anton V. Molochkov

Moscow Regional Research and Clinical Institute

Email: antmd@yandex.ru
ORCID iD: 0000-0002-6456-998X
SPIN-code: 8853-5050

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

Albina N. Khlebnikova

Moscow Regional Research and Clinical Institute

Email: alb9696@yandex.ru
ORCID iD: 0000-0003-4400-5631
SPIN-code: 7838-2703

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

Elizaveta D. Abalukhova

Moscow Regional Research and Clinical Institute

Email: ladybird2016@gmail.com
ORCID iD: 0009-0003-5831-4977
SPIN-code: 2642-7960
Russian Federation, Moscow

Elena V. Rusanova

Moscow Regional Research and Clinical Institute

Email: e.rysanova@monikiweb.ru
ORCID iD: 0000-0002-7996-2944
SPIN-code: 8855-4265

Ph.D. (Med.), Leading Researcher of the Laboratory of Biomedical Research Methods; Associate Professor of the Department of Inorganic and Analytical Chemistry

Russian Federation, Moscow

Viktoria V. Shchelkova

Moscow Regional Research and Clinical Institute; The Kosygin State University of Russia

Email: victoria.shchelkova@yandex.ru
ORCID iD: 0000-0001-9173-5464
SPIN-code: 1662-8142
Russian Federation, Moscow; Moscow

Galiya R. Setdikova

Moscow Regional Research and Clinical Institute

Email: galiya84@mail.ru
ORCID iD: 0000-0002-5262-4953
SPIN-code: 6551-0854

MD, Dr. Sci. (Medicine)

Russian Federation, Moscow

Elena V. Zenkevich

Moscow Regional Research and Clinical Institute

Email: zelen170778@yandex.ru
ORCID iD: 0000-0003-1978-1065
SPIN-code: 8220-0876
Russian Federation, Moscow

References

  1. Oremović L, Lugović L, Vucić M, et al. Cicatricial alopecia as a manifestation of different dermatoses. Acta Dermatovenerol Croat. 2006;14(4):246–252.
  2. Lyakhovitsky A, Segal O, Galili E, et al. Diagnostic delay, comorbid hidradenitis suppurativa and the prognostic value of bacterial culture in folliculitis decalvans: A cohort study. J Dtsch Dermatol Ges. 2023;21(12):1469–1477. doi: 10.1111/ddg.15202
  3. Collier NJ, Allan D, Diaz Pesantes F, et al. Systemic photodynamic therapy in folliculitis decalvans. Clin Exp Dermatol. 2018;43(1):46–49. doi: 10.1111/ced.13238
  4. Miguel-Gómez L, Rodrigues-Barata AR, Molina-Ruiz A, et al. Folliculitis decalvans: Effectiveness of therapies and prognostic factors in a multicenter series of 60 patients with long-term follow-up. J Am Acad Dermatol. 2018;79(5):878–883. doi: 10.1016/j.jaad.2018.05.1240
  5. Vañó-Galván S, Saceda-Corralo D, Blume-Peytavi U, et al. Frequency of the types of alopecia at twenty-two specialist hair clinics: A multicenter study. Skin Appendage Disord. 2019;5(5):309–315. doi: 10.1159/000496708
  6. Bolduc C, Sperling LC, Shapiro J. Primary cicatricial alopecia: Other lymphocytic primary cicatricial alopecias and neutrophilic and mixed primary cicatricial alopecias. J Am Acad Dermatol. 2016;75(6):1101–1117. doi: 10.1016/j.jaad.2015.01.056
  7. Matard B, Donay JL, Resche-Rigon M, et al. Folliculitis decalvans is characterized by a persistent, abnormal subepidermal microbiota. Exp Dermatol. 2020;29(3):295–298. doi: 10.1111/exd.13916
  8. Powell JJ, Dawber RP, Gatter K. Folliculitis decalvans including tufted folliculitis: clinical, histological and therapeutic findings. Br J Dermatol. 1999;140(2):328–333. doi: 10.1046/j.1365-2133.1999.02675.x
  9. Chiarini C, Torchia D, Bianchi B, et al. Immunopathogenesis of folliculitis decalvans: clues in early lesions. Am J Clin Pathol. 2008;130(4):526–534. doi: 10.1309/NG60Y7V0WNUFH4LA
  10. Iorizzo M, Starace M, Vano-Galvan S, et al. Refractory folliculitis decalvans treated with adalimumab: A case series of 23 patients. J Am Acad Dermatol. 2022;87(3):666–669. doi: 10.1016/j.jaad.2022.02.044
  11. Eyraud A, Milpied B, Thiolat D, et al. Inflammasome activation characterizes lesional skin of folliculitis decalvans. Acta Derm Venereol. 2018;98(6):570–575. doi: 10.2340/00015555-2924
  12. Vañó-Galván S, Molina-Ruiz AM, Fernández-Crehuet P, et al. Folliculitis decalvans: A multicentre review of 82 patients. J Eur Acad Dermatol Venereol. 2015;29(9):1750–1757. doi: 10.1111/jdv.12993
  13. Cheng C, Sun J, Zheng F, et al. Molecular identification of clinical “difficult-to-identify” microbes from sequencing 16S ribosomal DNA and internal transcribed spacer 2. Ann Clin Microbiol Antimicrob. 2014;13:1. doi: 10.1186/1476-0711-13-1 EDN: JURRMY
  14. Kinoshita-Ise M, Fukuyama M, Ohyama M. Recent advances in understanding of the etiopathogenesis, diagnosis, and management of hair loss diseases. J Clin Med. 2023;12(9):3259. doi: 10.3390/jcm12093259 EDN: QDSOWG
  15. Alsantali A, Baghdadi R, Alghamdi Y, et al. Folliculitis decalvans managed with adalimumab: A case report. Clin Case Rep. 2023;11(12):e8193. doi: 10.1002/ccr3.8193 EDN: TCWBRE
  16. Rathod DG, Muneer H, Masood S. Phototherapy. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
  17. Elsayad K, Kriz J, Haverkamp U, et al. Treatment of folliculitis decalvans using intensity-modulated radiation via tomotherapy. Strahlenther Onkol. 2015;191(11):883–888. doi: 10.1007/s00066-015-0891-6 EDN: OGPSAC
  18. Umar S, Waterman A, Ton D, Shitabata P. Refractory folliculitis decalvans treatment success with a novel surgical excision approach using guarded high-tension sutures. Clin Cosmet Investig Dermatol. 2023;16:2381–2390. doi: 10.2147/CCID.S422077 EDN: FTXCYG
  19. Meesters AA, Wietze van der Veen JP, Wolkerstorfer A. Long-term remission of folliculitis decalvans after treatment with the long-pulsed Nd:YAG laser. J Dermatolog Treat. 2014;25(2):167–168. doi: 10.3109/09546634.2013.826340
  20. Yip L, Barrett TH, Harries MJ. Folliculitis decalvans and lichen planopilaris phenotypic spectrum: A case series of biphasic clinical presentation and theories on pathogenesis. Clin Exp Dermatol. 2020;45(1):63–72. doi: 10.1111/ced.13989
  21. Iorizzo M, Starace M, Vano-Galvan S, et al. Refractory folliculitis decalvans treated with adalimumab: A case series of 23 patients. J Am Acad Dermatol. 2022;87(3):666–669. doi: 10.1016/j.jaad.2022.02.044 EDN: HDHXXZ
  22. Ismail FF, Sinclair R. Successful treatment of refractory folliculitis decalvans with secukinumab. Australas J Dermatol. 2020;61(2):165–166. doi: 10.1111/ajd.13190
  23. Fässler M, Radonjic-Hoesli S, Feldmeyer L, et al. Successful treatment of refractory folliculitis decalvans with apremilast. JAAD Case Rep. 2020;6(10):1079–1081. doi: 10.1016/j.jdcr.2020.08.019 EDN: JXRSIX
  24. Le Calvé C, Abi-Rached H, Vicentini C, et al. Treatment of folliculitis decalvans by photodynamic therapy using a new light-emitting device: A case series of 4 patients. JAAD Case Rep. 2021;17:69–72. doi: 10.1016/j.jdcr.2021.09.026 EDN: GTMIHM
  25. Jerjen R, Meah N, Trindade de Carvalho L, et al. Folliculitis decalvans responsive to tofacitinib: A case series. Dermatol Ther. 2020;33(6):e13968. doi: 10.1111/dth.13968 EDN: PKNAVJ
  26. Łusiak-Szelachowska M, Międzybrodzki R, Drulis-Kawa Z, et al. Bacteriophages and antibiotic interactions in clinical practice: What we have learned so far. J Biomed Sci. 2022;29(1):23. doi: 10.1186/s12929-022-00806-1 EDN: WKSOBC
  27. King B, Ohyama M, Kwon O, et al.; BRAVE-AA Investigators. Two phase 3 trials of baricitinib for alopecia areata. N Engl J Med. 2022;386(18):1687–1699. doi: 10.1056/NEJMoa2110343 EDN: EXVANM
  28. Kurz B, Berneburg M, Bäumler W, Karrer S. Phototherapy: Theory and practice. J Dtsch Dermatol Ges. 2023;21(8):882–897. doi: 10.1111/ddg.15126 EDN: CKDLIK
  29. Plumet L, Ahmad-Mansour N, Dunyach-Remy C, et al. Bacteriophage therapy for Staphylococcus aureus infections: A review of animal models, treatments, and clinical trials. Front Cell Infect Microbiol. 2022;12:907314. doi: 10.3389/fcimb.2022.907314 EDN: JZOTUI
  30. Kunz Coyne AJ, Stamper K, Bleick C, et al. Synergistic bactericidal effects of phage-enhanced antibiotic therapy against MRSA biofilms. Microbiol Spectr. 2024;12(4):e0321223. doi: 10.1128/spectrum.03212-23 EDN: GBZJCJ
  31. Moussa A, Asfour L, Eisman S, et al. Successful treatment of folliculitis decalvans with baricitinib: A case series. Australas J Dermatol. 2022;63(2):279–281. doi: 10.1111/ajd.13786 EDN: DFCINH
  32. Abraham D, Lescoat A, Stratton R. Emerging diagnostic and therapeutic challenges for skin fibrosis in systemic sclerosis. Mol Aspects Med. 2024;96:101252. doi: 10.1016/j.mam.2024.101252 EDN: DIZJUB

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2. Fig. 1. Histologic examination: a ― skin flap, partially covered with multilayer squamous epithelium, partially eroded; sebaceous glands are completely absent (Color: hematoxylin and eosin, ×50); b ― expressed inflammatory parafollicular infiltration with admixture of plasmocytes, segmented leukocytes; one dilated orifice contains several hair shafts (Color: hematoxylin and eosin, ×200); c ― multinucleated cells of foreign body type are seen in the inflammatory infiltrate (Color: hematoxylin and eosin, ×400); d ― fibrous changes in the parafollicular zone (Color: hematoxylin and eosin, ×400). Photo from the archive of Setdikova G.R. et al., 2024; published for the first time with permission of the administration.

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3. Fig. 2. Patient, 34 years old, with folliculitis decalvans: scalp condition before (a) and after (b) treatment Photo from the archive of Setdikova G.R. et al., 2024; published for the first time with permission of the administration.

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4. Fig. 3. Patient, 56 years old, diagnosed with decalving folliculitis: scalp skin condition before (a) and after (b) treatment. The arrow indicates a pustule Photo from the archive of Setdikova G.R. et al., 2024; published for the first time with permission of the administration.

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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