Perifolliculitis Capitis Abscedens et Suffodiens Treatment & Management

Updated: May 10, 2018
  • Author: Malgorzata D Skibinska, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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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. [28, 29, 30, 31] The successful use of oral acitretin and alitretinoin has also been reported. [32, 11] Successful treatment with topical isotretinoin (not available in the United States) has been described in 1 patient. [33]

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. [34, 35, 36] Oral zinc sulfate has been used effectively in two patients, [37, 38] and biologic agents such as adalimumab and infliximab have also been successful. [39, 40, 41, 42, 43, 44]

Compression therapy was reported as being effective in one patient. [45]

Laser ablation and epilation

Carbon dioxide laser ablation [46] and epilation of hair follicles with an 800-nm diode laser [47] and long-pulse non ̶ Q-switched ruby laser was tried in a single patient, [48] with good results. Repeated treatments with a long-pulsed Nd:YAG laser were used in 4 patients, with some improvement. [49]

Radiation therapy

Successful X-ray epilation has been reported. [50] Chinnaiyan et al reported good results in four patients with intractable PCAS who were treated with a modified form of external beam radiation. [51] A case report described improvement of PCAS with brachytherapy treatment. [52]

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. [53, 54, 55]

Photodynamic therapy

Treatment of PCAS with aminolevulinic acid photodynamic therapy (ALA-PDT) has been reported in single patients with conflicting results. [56, 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.