Perifolliculitis Capitis Abscedens et Suffodiens Treatment & Management

Updated: Apr 12, 2016
  • Author: Malgorzata D Skibinska, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
  • Print
Treatment

Approach Considerations

Perifolliculitis capitis abscedens et suffodiens (PCAS) is a chronic disease with an unpredictable course. Several medications are used to treat PCAS, but many give disappointing results. [5, 6]

Oral isotretinoin may be considered the treatment of choice. [23, 24, 25, 26] The successful use of oral acitretin and alitretinoin has also been reported. [27, 11] Successful treatment with topical isotretinoin (not available in the United States) has been described in 1 patient. [28]

Intralesional corticosteroids (eg, triamcinolone acetonide) can be injected into boggy nodules and sinus tracts to decrease inflammation. Their benefit, however, is short-lived; intralesional corticosteroids should be considered a temporizing measure.

According to case reports, antibiotics such as doxycycline, ciprofloxacin, rifampicin, and dapsone have been used successfully in PCAS. [29, 30, 31] Oral zinc sulfate has been used effectively in two patients, [32, 33] and biologic agents such as adalimumab and infliximab have also been successful. [34, 35, 36, 37, 38, 39]

Laser ablation and epilation

Carbon dioxide laser ablation [40] and epilation of hair follicles with an 800-nm diode laser [41] and long-pulse non ̶ Q-switched ruby laser was tried in a single patient, [42] with good results. Repeated treatments with a long-pulsed Nd:YAG laser were used in 4 patients, with some improvement. [43]

X-ray epilation

Successful X-ray epilation has been reported, [44] but the authors do not currently recommend it. However, Chinnaiyan et al reported good results in 4 patients with intractable PCAS who were treated with a modified form of external beam radiation. [45]

Surgical excision

Surgical excision of lesions should be considered in severe or recalcitrant cases. Wide excision of the affected areas and split-thickness skin grafting are favored by some as the treatment of choice. [46, 47, 48]

Photodynamic therapy

Treatment of PCAS with aminolevulinic acid photodynamic therapy (ALA-PDT) has been reported in single patients with conflicting results. [49, 11]

Monitoring

People with PCAS taking isotretinoin should be seen monthly during therapy, and afterwards every 2-3 months. Additional appointments should be made if any sign of relapse appears.