title: Treatment of folliculitis decalvans using intensity-modulated radiation via tomotherapy.
abstract: BACKGROUND
  Folliculitis decalvans (FD) is a form of primary neutrophilic scarring alopecia that is characterized clinically by chronic suppurative folliculitis and often associated with pruritus or even pain. Treatment of FD is often difficult. Herein, we report a case of recalcitrant and painful folliculitis decalvans refractory to antibiotic and anti-inflammatory therapies, which was successfully treated by intensity-modulated radiotherapy (IMRT) in order to irreversibly eliminate hair follicles that prove to be one etiological trigger.
  
  
  METHODS
  A 45-year-old male patient with a refractory FD presented with a crusting suppurative folliculitis and atrophic scarring patches on the scalp associated with pain and pruritus. We attempted relief of symptoms by reducing scalp inflammation and eliminating hair follicles through radiation. We delivered 11.0 Gy in two radiation series using tomotherapy, 5.0 Gy in 5 equivalent fractions as a first radiation course. The symptoms markedly decreased but did not totally disappear. Therefore, we delivered a second radiation series 4 months later with an additional 6 Gy. This led to almost complete epilation on the scalp and abolished pain and pruritus on the capillitium. The patient was regularly followed up until 26 months after radiotherapy. Draining lesions or exudation did not recur. He only experienced discrete hair regrowth in the occipital region with folliculitis 12 months after radiotherapy. These residual lesions are currently treated with laser epilation therapy.
  
  
  CONCLUSIONS
  A radical approach to eliminating hair follicles by repeated radiation therapy may induce lasting relief of symptoms in chronic suppurative FD associated with persistent trichodynia.
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany. khaled.elsayad@uni-muenster.de.
authors.forename: Khaled
authors.initials: K
authors.lastname: Elsayad
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Kriz
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Haverkamp
authors.affiliation: Department of Dermatology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Kerasia-Maria
authors.initials: KM
authors.lastname: Plachouri
authors.affiliation: Department of Dermatology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Antonia
authors.initials: A
authors.lastname: Jeskowiak
authors.affiliation: Department of Dermatology, University Hospital of Muenster, Muenster, Germany.|Department of Translational Dermatoninfectiology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Cord
authors.initials: C
authors.lastname: Sunderkötter
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
authors.forename: Hans Theodor
authors.initials: HT
authors.lastname: Eich
mesh_terms: D005499:Folliculitis / Q000473:pathology* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069473:Radiation Dose Hypofractionation; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012536:Scalp Dermatoses / Q000473:pathology* / Q000532:radiotherapy*; D016896:Treatment Outcome
keywords: Case report; Folliculitis decalvans; Intensity-modulated radiation therapy; Pruritus; Tomotherapy