[Dapsone treatment of folliculitis decalvans].
BACKGROUND
Folliculitis decalvans consists of recurrent patchy painful folliculitis of the scalp causing scarring alopecia. The physiopathology of this condition is still unclear, but is likely a manifestation of chronic neutrophilic bacterial folliculitis. Numerous topical and systemic treatments (corticosteroids, antistaphylococcal antibiotics) have been used with variable results. Based on the dapsone antimicrobial activity and its anti-inflammatory action especially directed to the neutrophil metabolism, we treated two patients with severe folliculitis decalvans with this drug.


METHODS
The patients were treated with dapsone at a daily dose of 75 and 100 mg, respectively for 4 to 6 months. After 1 and 2 months, pustular folliculitis progressively cleared, leaving a residual non inflammatory cicatricial alopecia. When maintaining a dapsone dosage at 25 mg/day no relapse occurred during 3 years and 1 year, respectively. No important adverse effect to dapsone was evidenced. After dapsone withdrawal, a moderate relapse of the disease with pruritus and folliculitis occurred after a few weeks in both cases. The disease relapse rapidly cleared after dapsone reintroduction at a daily dose of 25 mg.


CONCLUSIONS
Dapsone at moderate dosage was well tolerated and rapidly effective in treating the two cases of folliculitis decalvans. A long term and low dose (25 mg daily) maintenance treatment avoided disease relapses.
Paquet
P
P
Service de Dermatopathologie, CHU du Sart Tilman, B-4000 Liège, Belgium. P.Paquet@chu.ulg.ac.be
Piérard
G-E
GE
D000328:Adult; D000368:Aged; D000505:Alopecia / Q000188:drug therapy* / Q000209:etiology; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003622:Dapsone / Q000627:therapeutic use*; D005260:Female; D005499:Folliculitis / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male
D000890:Anti-Infective Agents; D003622:Dapsone