Perforating Folliculitis Treatment & Management

Updated: May 25, 2018
  • Author: Suguru Imaeda, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

Since some cases of perforating folliculitis are associated with systemic disorders (eg, diabetes mellitus, chronic renal failure), direct therapeutic efforts towards the underlying condition in these patients. In a case report of perforating folliculitis in a patient with diabetes mellitus and phrynoderma, the skin lesions resolved with correction of the vitamin A deficiency. Soothing antipruritic lotions may be helpful for patients in whom itching is a significant problem. UV-B irradiation also may be of general benefit in the control or amelioration of pruritus. [30]

Assessing treatments for perforating folliculitis is difficult. Although the condition is not uncommon, controlled therapeutic studies are not available. Unsuccessful treatments have included oral beta-carotene, keratolytics, antiacne therapies, and topical corticosteroids. A case of perforating folliculitis reported by Zachariae and Sogaard featured progressive generalized perforating folliculitis combined with erythroderma, keratoderma, and alopecia and was resistant to corticosteroids, corticotropin, psoralen plus UV-A, cytostatic agents, and aromatic retinoids. [31] A case of phrynoderma with perforating folliculitis reported by Neill et al responded to 50,000 U/d of beta-carotene for 1 month, followed by 2000 U/d. [15] Hurwitz found that a combination of antistaphylococcal therapy, phototherapy, and a topical corticosteroid lotion was helpful in controlling perforating folliculitis in patients with chronic renal failure. [6]

Tretinoin 0.1% cream has cleared some perforating folliculitis lesions but has not prevented the development of others. A case of successful treatment using 13-cis -retinoic acid has been reported. [32]

A 2004 study of 5 perforating folliculitis patients showed good clinical responses with narrowband UV-B therapy. Patients were treated 2-3 times weekly. The initial dose was 400 mJ/cm2, with increases to a maximum of 1500 mJ/cm2. Lesions completely resolved after 10-15 exposures, although some recurrences were observed. [30]

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Surgical Care

Surgical intervention is not required for perforating folliculitis lesions.

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Consultations

Dermatologist

Practitioners may wish to consult a dermatologist when uncertainty regarding a papular eruption exists in a patient. Dermatologists often are able to determine clinically whether such an eruption is likely to be a folliculitis, and they can appreciate subtle lesional changes that suggest a perforating folliculitis. Dermatologists also can suggest or perform the proper type of biopsy procedure for this type of folliculitis.

Internist

Specialists in internal medicine should be consulted for management of patients in whom perforating folliculitis may be associated with an underlying medical condition, such as chronic renal failure, diabetes mellitus, or atherosclerotic cardiovascular disease.

General surgeon

Consultation with a surgeon may be indicated for patients whose perforating folliculitis is associated with chronic renal failure. Renal transplantation may be an option. [7]

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Long-Term Monitoring

Further outpatient dermatologic care may be required for ongoing management of the perforating folliculitis when lesions persist, spread, or become resistant to therapy.

Follow-up care may be necessary for complications related to therapy.

Outpatient internal medicine care may be indicated for management of any underlying medical conditions, such as chronic renal failure, hypertension, diabetes mellitus, or atherosclerotic cardiovascular disease.

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