Perifolliculitis Capitis Abscedens et Suffodiens Medication

  • Author: Malgorzata D Skibinska, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 17, 2011
 

Medication Summary

No single, effective treatment is available because the etiology of perifolliculitis capitis abscedens et suffodiens (dissecting cellulitis of the scalp) is unknown.[22] Antibiotics are not a standard treatment because bacterial infection is a secondary event. Intralesional steroid injections may be helpful in early stages of the disease. Oral zinc sulfate[23, 24] was successful in 2 patients at 400 mg tid and 135 mg tid for 3 months, respectively. Topical isotretinoin was described as a successful treatment of perifolliculitis capitis abscedens et suffodiens (dissecting cellulitis of the scalp) in one patient.[25] Single case reports were published on patients treated with combinations of isotretinoin and rifampicin,[26] isotretinoin and dapsone,[27] infliximab,[28] and adalimumab.[29, 30]

The best results have been reported with oral isotretinoin, which may be helpful in the follicular retention aspect of the disease. A long course is considered the most effective treatment, with a daily dose of 1 mg/kg/d for approximately 4 months and then not less than 0.75 mg/kg for another 6-7 months. To avoid relapses, continue the treatment for approximately 4 months after the disease seems to be clinically inactive.[31, 32, 33, 34, 35]

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Retinoids

Class Summary

Decrease cohesiveness of abnormal hyperproliferative keratinocytes and may reduce potential for malignant degeneration. Modulate keratinocyte differentiation. Have been shown to reduce risk of skin cancer formation in renal transplant patients.

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Isotretinoin (Accutane)

 

Oral agent that treats serious dermatologic conditions. Synthetic 13-cis isomer of the naturally occurring tretinoin (trans -retinoic acid). Both agents are structurally related to vitamin A.

First-line treatment in perifolliculitis capitis abscedens et suffodiens (dissecting cellulitis of the scalp) because of its influence on pilosebaceous unit. Changes pattern of keratinization of follicle and has anticomedogenic effect, reduces sebaceous glands size and activity, and reduces bacterial flora. Also has some anti-inflammatory effect.

A US Food and Drug Administration–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information on this registry, see iPLEDGE. This registry aims to further decrease the risk of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.

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Contributor Information and Disclosures
Author

Malgorzata D Skibinska, MD, PhD  Locum Consultant Dermatologist, Department of Dermatology, Basildon University Hospital, UK

Malgorzata D Skibinska, MD, PhD is a member of the following medical societies: British Association of Dermatologists, British Medical Association, British Society of Allergy and Clinical Immunology, Royal College of Physicians of the United Kingdom, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Leonard Sperling, MD  Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences

Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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  31. Bjellerup M, Wallengren J. Familial perifolliculitis capitis abscedens et suffodiens in two brothers successfully treated with isotretinoin. J Am Acad Dermatol. Oct 1990;23(4 Pt 1):752-3. [Medline].

  32. Dubost-Brama A, Delaporte E, Alfandari S, Piette F, Bergoend H. [Perifolliculitis capitis abscedens and suffidiens. Efficacy of isotretinoin]. Ann Dermatol Venereol. 1994;121(4):328-30. [Medline].

  33. Koca R, Altinyazar HC, Ozen OI, Tekin NS. Dissecting cellulitis in a white male: response to isotretinoin. Int J Dermatol. Aug 2002;41(8):509-13. [Medline].

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  35. Schewach-Millet M, Ziv R, Shapira D. Perifolliculitis capitis abscedens et suffodiens treated with isotretinoin (13-cis-retinoic acid). J Am Acad Dermatol. Dec 1986;15(6):1291-2. [Medline].

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  37. Sivakumaran S, Meyer P, Burrows NP. Dissecting folliculitis of the scalp with marginal keratitis. Clin Exp Dermatol. Sep 2001;26(6):490-2. [Medline].

 
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Dissecting cellulitis in a black man. Painful cutaneous nodules and patchy alopecia.
Side view of a black man with painful cutaneous nodules and patchy alopecia, characteristic of dissecting cellulitis.
A white patient with painful nodules. Image used with permission from Medical Science Monitor, 2000, 6(3): 602-4.
A white patient with painful nodules after 3 months of isotretinoin treatment. Image used with permission from Medical Science Monitor, 2000, 6(3): 602-4.
Histopathologic picture of biopsy taken from a white patient with perifolliculitis capitis abscedens et suffodiens. Hematoxylin and eosin stain, original magnification 400X. Image used with permission from Medical Science Monitor, 2000, 6(3): 602-4.
 
 
 
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