Folliculitis decalvans

The decalvans Folliculitis is an inflammation of the hair follicles, which occurs rarely and is chronic. Inflammation occurs Due to a loss of hair with replacement by scar tissue ( = scarring alopecia ).

Other names for this skin disorder are: Quinquaudsche disease, folliculitis depilans, Acne décalvante.

Introduction and Epidemiology

For the first time this disease was described by Quinquaud in 1888. This isolated bacteria from the hair follicles of affected patients and brought them to rats, mice and rabbits, but without success. In 1905, the Quinquaudsche disease by Brocq et al. distinguished from other scarring alopecia and introduced the still existing designation of folliculitis decalvans. Prorated approximately 11% of primary cicatricial alopecia of folliculitis decalvans Act. Men are affected more often than women and the occurrence focuses on the early to middle adulthood. After studying in the United States of America African Americans are affected more often than light-skinned Americans.

Cause

About the cause of the disease, there is no final clarity, certainly, however, is that the Gram- positive bacterium Staphylococcus aureus has a central role. This bacterium is detected in the majority of patients with this disease in the lesions. Whether a sterile primary infection with secondary colonization by Staphylococcus aureus is present or this bacterium primarily leads to a strong immune response is still unclear. Could also be caused by the bacteria toxins formed as superantigens that activate T cells via the variable domain of the T cell receptor directly, act. In any case, can be detected in almost all patients with this disease Staphylococcus aureus, which is in the " normal population " otherwise on the skin only in 20-30% of cases.

However, since not all colonized with Staphylococcus aureus people also suffer from folliculitis decalvans, there must be other factors. Through studies in families could be found that there is a family history and so we have come to the conclusion of a genetic predisposition, which may manifest itself, for example, that patients with Folliculitis decalvans possess an innate different kind Haarfollikelöffnung that a could facilitate self- implantation of the bacteria. Also, considered immunologically, which is particularly strongly expressed intercellular anchoring protein ICAM -1 to attract with its enhanced effect, neutrophils and lymphocytes (white blood cells) that contribute to increased inflammation.

Clinical picture

At the beginning of the disease occur follicular papules and pustules later. The lesions below, if not treated, peripherally towards continued and left central scar, which is accompanied by irreversible ( irrecoverable ) hair loss. Hemorrhagic crusts, erosions, spontaneous bleeding, itching, pain and burning sensations may also occur. The hair loss is not predictable. Although folliculitis decalvans can occur in all hairy areas (such as have been described: in the area of the beard, the neck, armpit or pubic region ), it is nevertheless the head of the most frequent site of manifestation.

Diagnostics

The diagnosis is based on the following major pillars:

• A smear, usually from the scalp or according to the affected body areas, at best, equal with production on susceptibility testing and possibly a nasal swab to identify occult settlement places.
• Preparation of a culture (for detection of pathogens ) from an intact pustule.
• Biopsy with histological analysis. Shortens said this a chronic suppurative folliculitis and Perifollikulitis can be determined. Initially is typically a Perifollikulitis with destruction of the hair follicle, which is characterized by the additional presence of small abscesses and accumulation of neutrophils particularly ( = white blood cells) in the further course. With continued disease activity forms in the course of granulation tissue and in the fired state, the image of fibrosis is visible.
• The reflected light microscopy can be helpful to detect follicular ostia, perifollicular erythema and follicular hyperkeratosis.

Therapy

The main goal of therapy may eradication of Staphylococcus aureus are formulated. It is the treatment of choice an anti- inflammatory therapy and antibiotic therapy. Both possibilities can be applied externally to the skin or administered internally.

External: topical should be applied as a sole therapy in moderate cases of folliculitis decalvans, usually they are a concomitant therapy represents the antimicrobial therapy of the applied skin means can with 2% erythromycin - containing solutions, 2% mupirocin, 1% clindamycin or fusidic acid 1.5% done. Also Glukokortikoidcremes Class 1-2 are used and can be applied twice daily. However, the period of use is limited.

Internal: The main drugs of internal therapy are the antibiotics dar. rifampicin 300 mg twice daily for 10-12 weeks is the best effect against Staphylococcus aureus and the best long-term effect is said. On the basis of the development of resistance of this antibiotic should also be combined with clindamycin or ciprofloxacin. The most commonly used therapy is the antibiotic tetracycline which initially 1 g / day per os and a subsequent dose reduction to 500 mg / day should be dosed. Discontinuation of antibiotic therapy can lead to a relapse of disease activity, which could make up for years of possible eventual therapy extension even. A therapeutic trial with systemic isotretinoin can be sampled. At higher inflammation, so higher disease activity, may in the short term glucocorticoids in intermediate-dose 60-80 mg / day are used (eg Decortin H) in descending dose. In a therapy-resistant single case, the combination of isotretinoin, clindamycin, and prednisolone was successful. (PDF, 113 kB)

Other approaches in the therapy represent the oral administration of zinc sulfate or fusidic acid, or an internal treatment with dapsone. Since hair loss is irreversible and unpredictable, therapy should start as early as possible. In addition, it is advisable to bring twice daily 2% or 5% minoxidil for use on locally not yet scarred areas.