Medication Summary
Medical therapy for Fox-Fordyce disease has been complicated by the irritant potential of the topical medications. Topical steroids have not been useful. Topical retinoids have been irritating, which has limited their long-term use. In 1979, Giacobeti reported success with topical 0.1% tretinoin cream. In 1990, Casani reported treatment with topical 0.5% tretinoin cream. In 1995, Miller et al reported treatment of Fox-Fordyce disease with topical clindamycin solution. [15]
Hormonal therapy for Fox-Fordyce disease with high-estrogen oral contraceptives, estrogen creams, and testosterone creams has been reported.
In 2006, Pock et al reported effective therapy, with no adverse effects, using pimecrolimus in 3 young female patients. [19] The response was deemed "very impressive." Based on this report, the drug of choice could be this class of drug, which includes tacrolimus. Tacrolimus was found to safe and effective in treating one of two patients. [20]
There has been a single reported case of refractory Fox-Fordyce disease successfully treated with calcipotriol-betamethasone. [21]
There are also reported cases of successful treatment using botulinum toxin type A. [22]
Retinoids
Class Summary
Based on follicular infundibular occlusion, the retinoids (first tretinoin, later isotretinoin) have been used with reported short-term success. Consider therapy with alternative retinoids as they become available. Based on the success of tretinoin, oral retinoids have also been used with reported success.
Tretinoin topical (Avita, Retin-A)
Since 1972, therapy with topical retinoids has the most support in the literature. Several reports exist on the efficacy of topical tretinoin. Severe irritation may occur when used in the axillae. The 0.025% cream, or even a dilution to a milder form or short contact therapy, would be prudent to begin therapy.
Increasing both the time and the amount gradually as tolerated is a safe way to avoid irritation.
Isotretinoin (Accutane)
By analogy, because isotretinoin worked topically, it was predicted that oral retinoids would be effective. Low doses of isotretinoin have been efficacious. Although symptoms were relieved at relatively low doses, the condition returned in a few months after cessation of therapy.
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.
Antibiotics
Class Summary
Topical clindamycin in propylene glycol was first reported to help patients with Fox-Fordyce disease in 1992. Confirmation of this study was reported in 1995. Topical erythromycin should also be helpful.
Clindamycin topical (Cleocin-T)
Clindamycin topical is a lincosamide for the treatment of serious skin and soft tissue staphylococcal infections. It is also effective against aerobic and anaerobic streptococci (except enterococci). It inhibits bacterial growth, possibly by blocking the dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Erythromycin topical (AkneMycin, Ery)
Erythromycin topical inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is used in the treatment of staphylococcal and streptococcal infections.
Immunosuppressive Agents, Topical
Pimecrolimus (Elidel)
Because of the rapidity of response, effectiveness of therapy, and lack of adverse effects, this could be current drug of choice. It is in immunomodulating macrolactam (neuraminidase inhibitors) class of drugs and has significant anti-inflammatory activity and a highly favorable adverse effect profile in at least the short range. It is especially safe to use in the axilla, periareolar, and groin areas.
Tacrolimus ointment (Protopic)
Because of the rapidity of response, effectiveness of therapy, and lack of adverse effects, this could be current drug of choice. It is in immunomodulating macrolactam (neuraminidase inhibitors) class of drugs and has significant anti-inflammatory activity and a highly favorable adverse effect profile in at least the short range. It is especially safe to use in the axilla, periareolar, and groin areas.
