Title : Exploring an unorthodox therapy for folliculitis decalvans: A Case Study
Abstract:
Folliculitis decalvans is a rare, chronic inflammatory scalp condition that is characterized by scarring alopecia resulting in permanent hair loss, neutrophilic inflammation, tufted folliculitis, and scaling of the scalp. This condition accounts for 10% of primary cicatricial alopecias. A 44-year-old male with 15-year history of folliculitis decalvans and scarring alopecia presented to our clinic for follow-up. Previous treatments include oral doxycycline, minocycline, cephalexin, clindamycin/rifampin, topical antibiotics, topical steroids, Zoreve, intralesional steroids, isotretinoin, and Otezla. At the time of presentation, the patient was experiencing itching, flaking, and tenderness along the right scalp that was exacerbated by heat and sweat. With recent cases of nonscarring androgenic alopecia being treated with botulinum toxin A and showing improvement, and in consideration of the patient's previous history of failed conventional therapies, it was decided to treat this patient with botulinum toxin A. Over the course of a 3-month period, the patient received intradermal botulinum injections at the sites most predominantly affected. The patient observed noticeable symptom improvement over the course of treatment, specifically with regard to tenderness, inflammation, and itching. Additionally, cessation of additional hair loss was noted. While the evidence to support this treatment is limited, the opportunity for improved outcomes is immense due to the obstacles folliculitis decalvans presents both providers and patients in treating the physiologic and psychologic impacts of this disease. This highlights a growing need for research to be done to further explore the mechanism behind how variable treatment modalities affect disease development and progression of folliculitis decalvans.
