Turpentine Ointment for the Treatment of Folliculitis: An Open, Prospective, Randomized, Placebo- and Comparator-Controlled Multicenter Trial.

INTRODUCTION: Folliculitis is a painful infection and inflammation of the hair follicles, mostly caused by bacterial, fungal, or, more rarely, viral infections. Turpentine derivatives have been used traditionally to treat various skin infections and could thus also be effective in treating folliculitis. We carried out an open, prospective, randomized, placebo- and comparator-controlled multicenter trial to evaluate the efficacy and safety of an ointment containing pine turpentine oil, larch turpentine, and eucalyptus oil in the treatment of acute folliculitis. METHODS: Seventy outpatients with acute folliculitis were treated with the turpentine ointment, a comparator (povidone iodine solution), or a placebo (Vaseline) for 7 days. Photographs of the affected skin areas were taken by the physicians at four visits and by the patients on a daily basis. Photographs were evaluated by blinded observers. Primary efficacy endpoint was the change in total hair follicle lesion counts. Secondary endpoints included the evolution of the lesion counts in the course of the study, responder rate (improvement of follicle lesions by at least one count), and the patient's global assessment. Safety endpoints were the tolerability of the treatments and adverse event recording. RESULTS: A decrease of follicle lesions counts was detected for both active treatments but not for placebo, but the differences among groups were not statistically significant. As for the secondary endpoints, the ointment showed statistically significant superiority over placebo for the evolution of the lesions during the course of the study (p = 0.017), the responder rate (p = 0.032), and the subjective efficacy assessment by patients (p = 0.029). All treatments were equally well tolerated, with a similar number of treatment-emergent adverse events. CONCLUSION: The turpentine ointment is an effective and safe option for the treatment of folliculitis.

Successful Treatment with Fusidic Acid in a Patient with Folliculitis Decalvans.

Dear Editor, Folliculitis decalvans (FD) is a rare form of primary neutrophilic cicatricial alopecia. It is a highly distressing disease that affects young and middle-aged adults, with a slight male predominance (1). The most frequent clinical manifestations are follicular pustules and diffuse and perifollicular erythema that heal with centrifugal scarring. Follicular tufting, erosions, and hemorrhagic crusts can also be present, and this alopecia is most often located at the vertex and occipital area. Patients frequently complain about pain, itching, or burning sensations, and the involvement of other body areas is rare (2). The pathogenesis of this disease remains unclear. Staphylococcus aureus and other hair follicle bacteria can often be isolated from the pustules, suggesting the role of a bacterial infection in its etiology. A defect in the host's immune response can also be postulated by reports of familial cases and the appearance of FD in patients with immunity dysfunctions. Other mechanical factors have been suggested, such as structural abnormalities of the follicle or local inflammation (2). Management of this alopecia is difficult and its course is typically chronic and relapsing. The treatment aim is to stop inflammation and further irreversible destruction of hair follicles. Antibiotics remain the first-line therapy, due both to their anti-inflammatory and antimicrobial properties (1). Although topical fusidic acid is widely used as adjuvant treatment, there are few data regarding its oral use. We report a case of folliculitis decalvans successfully treated with oral fusidic acid. Our patient was a 41-year old Cape Verdean woman with a two month history of alopecia with painful, purulent discharge at the vertex of the scalp. The patient was diagnosed with human immunodeficiency virus type 1 (HIV-1) infection 5 years prior and was stable on her regimen of efavirenz, tenofovir, and emtricitabine, with undetectable viral load. She denied application of topical or capillary products. Dermatological examination revealed a patch of cicatricial alopecia with crusts and follicular pustules (Figure 1). Direct microscopic examination and mycological culture showed no fungal element. A diagnosis of folliculitis decalvans was established and the patient was started on oral fusidic acid at a dose of 500 mg three times a day. Betamethasone dipropionate 0.05% and salicylic acid 3% lotion as well as azelaic acid 5% lotion were also applied to the affected area once daily. After two months of treatment, the patient showed clinical improvement, with less erythema and suppuration of the affected scalp. A partial hair regrowth was noted, mainly at the periphery. Subsequently the patient maintained only topical therapy, and no recurrences were observed after 6-months of follow-up. Fusidic acid is useful in the treatment of skin and soft tissue infections, particularly those due to S. aureus, as shown by randomized controlled studies (3). The clinical efficacy of fusidic acid in the treatment of folliculitis decalvans has been reported previously. Bogg was the first to describe this useful effect (4). Sutter also reported good results with fusidic acid used both topically and orally (500 mg three times a day) (5). However, both failed to report the treatment duration or the outcome on discontinuation. Abeck described three patients that responded to a three week oral course of fusidic acid (500 mg three times a day) and to a maintenance treatment with zinc sulfate (4). During the following year, recurrence was observed in only one patient after ending zinc sulfate therapy. Oral antibiotics are frequently used to treat folliculitis decalvans. Tetracyclines and the combination of clindamycin with rifampicin are the most commonly used (2). However, the disease usually progresses when treatment is stopped. Fusidic acid is an anti-staphylococcal drug with few adverse effects. It is highly bioavailable orally, and has a long plasma half-life. Despite years of clinical use in numerous countries, resistance rates remain at low levels to date (6). Since clinical series or cases including ours have shown good results, this drug should not be forgotten when considering treatment options for folliculitis decalvans.

Eosinophilic pustular folliculitis: A published work-based comprehensive analysis of therapeutic responsiveness.

Eosinophilic pustular folliculitis (EPF) is a non-infectious inflammatory dermatosis of unknown etiology that principally affects the hair follicles. There are three variants of EPF: (i) classic EPF; (ii) immunosuppression-associated EPF, which is subdivided into HIV-associated (IS/HIV) and non-HIV-associated (IS/non-HIV); and (iii) infancy-associated EPF. Oral indomethacin is efficacious, especially for classic EPF. No comprehensive information on the efficacies of other medical management regimens is currently available. In this study, we surveyed regimens for EPF that were described in articles published between 1965 and 2013. In total, there were 1171 regimens; 874, 137, 45 and 115 of which were applied to classic, IS/HIV, IS/non-HIV and infancy-associated EPF, respectively. Classic EPF was preferentially treated with oral indomethacin with efficacy of 84% whereas topical steroids were preferred for IS/HIV, IS/non-HIV and infancy-associated EPF with efficacy of 47%, 73% and 82%, respectively. Other regimens such as oral Sairei-to (a Chinese-Japanese herbal medicine), diaminodiphenyl sulfone, cyclosporin and topical tacrolimus were effective for indomethacin-resistant cases. Although the preclusion of direct comparison among cases was one limitation, this study provides a dataset that is applicable to the construction of therapeutic algorithms for EPF.

Sebaceous adenitis and mural folliculitis in a cat responsive to topical fatty acid supplementation.

OBJECTIVE: To describe a case of feline sebaceous adenitis and mural folliculitis, and its successful treatment with topical fatty acids. ANIMAL: A 5-year-old, male castrated Norwegian Forest cat was presented with a progressive seborrhoeic dermatitis. METHODS: Clinical examination and histopathological examination of skin biopsies. RESULTS: There was severe, multifocal, lymphocytic mural folliculitis and perifollicular dermatitis, moderate hyperkeratosis and sebaceous adenitis on histopathology. Sebaceous glands were either absent or almost completely effaced by a dense lymphocytic infiltrate. Clinical signs began in spring on the face and neck and progressed over an 18 month period to involve the legs. Initially, topical and systemic antibacterial therapy for a mild bacterial overgrowth resulted in partial clinical response. There was no improvement with oral omega 6 fatty acids and surface cleaning. Treatment with a spot-on product containing essential oils, smoothing agents and vitamin E as the sole therapy was associated with a good--but incomplete--clinical response over a 6 month period, with hair regrowth and a marked decrease in seborrhoeic dermatitis. This improvement was sustained until 12 months later when a severe deep pyoderma with associated anorexia and depression occurred. This was symptomatically treated and the cat remained clinically stable for a further 18 months. Periocular and perinasal seborrhoea was a persistent feature. CONCLUSION AND CLINICAL IMPORTANCE: Topical essential fatty acid therapy may offer a viable alternative to ciclosporin, which has been reported for the successful treatment of this rare disease in cats.

Canine superficial bacterial folliculitis: current understanding of its etiology, diagnosis and treatment.

Superficial bacterial folliculitis (SBF) is more common in the dog than other mammalian species. Until recently, a successful outcome in cases of canine SBF was possible by administering a potentiated amoxicillin, a first generation cephalosporin or a potentiated sulfonamide. Unfortunately, this predictable susceptibility has changed, because methicillin resistant Staphylococcus pseudintermedius (MRSP) and Staphylococcus aureus (MRSA) are becoming more prevalent in canine SBF cases. The increasing frequency of multidrug resistance complicates the selection of antimicrobial therapy. Antimicrobial agents that were once rarely used in cases of canine SBF, such as amikacin, rifampicin and chloramphenicol, are becoming the drugs of choice, based on bacterial culture and susceptibility testing. Furthermore, changes in antimicrobial susceptibility have helped to re-emphasize the importance of a multimodal approach to treatment of the disease, including topical therapy. Due to the increasing frequency of identification of highly resistant Staphylococcus spp., topical antimicrobial therapy, including the use of diluted sodium hypochlorite (bleach), is becoming necessary to successfully treat some cases of canine SBF. Other important antiseptics that can be used include chlorhexidine, benzoyl peroxide, ethyl lactate, triclosan and boric acid/acetic acid. This review discusses the diagnostic and therapeutic management of canine SBF, with a special emphasis on treating methicillin resistant staphylococcal infections.

[Pseudofolliculitis barbae]. / Pseudofoliculitis de la barba.

Pseudofolliculitis barbae is a chronic, irritating, and potentially disfiguring condition that develops as a result of attempts to eliminate hair from the beard area, usually by shaving. It is difficult to determine the incidence of the disorder, but some studies report that it affects up to 1 of every 5 caucasian individuals and that it is much more common in black persons. Clinically it is characterized by the appearance of inflammatory papules and pustules. Once pseudofolliculitis has become established, treatment consists of avoiding shaving and the use of medical treatment similar to that used in acne. However, the long-term result is much more dependent on prevention through a correct shaving technique. In severe cases or when a definitive solution is sought, the treatment of choice is photodepilation.

A possible new cause of spa bath folliculitis: Aeromonas hydrophila.

A 34-year-old man presented with a pubic eruption of 4 weeks duration, affecting both himself and his partner. He had been treated unsuccessfully with intravenous and oral dicloxacillin. The eruption was a severely inflammatory folliculitis, with haemo-serous exudate and marked oedema. A clinical diagnosis of herpes simplex virus folliculitis was disproved when routine bacteriology isolated Aeromonas hydrophila and multiple viral polymerase chain reaction studies were negative. Histology demonstrated a chronic folliculitis with no organisms present. Both he and his partner were treated with oral ciprofloxacin 500 mg bd for 6 weeks with clinical clearance of infection, but both developed a scarring alopecia. Infection was attributed to possible contamination of a poorly maintained home spa bath with A. hydrophila.

Micosis fungoide folicular. Estudio de cuatro casos / Folliculotropic mycosis fungoides. Study of four cases

La micosis fungoide folicular (MFF) es una variante de micosis fungoide (MF) caracterizada por la presencia de infiltrados foliculares, a menudo respetando la epidermis, y con afectación preferente de cabeza y cuello. Presentamos nuestra experiencia con 4 casos de MFF vistos en nuestro Servicio en los últimos años. Se trata de 4 pacientes (tres varones y una mujer) con edades comprendidas entre los 45 y 68 años. Clínicamente las lesiones se presentaron en forma de quistes, comedones, pápulas foliculares y placas con acentuación folicular. El estudio histopatológico mostró un infiltrado de distribución peri e intrafolicular con la epidermis parcial o totalmente respetada. Este infiltrado estaba formado principalmente por linfocitos atípicos. Se apreciaban también algunas formaciones quísticas. En tres casos se observaron depósitos de mucina y en uno siringotropismo. El análisis inmunohistoquímico fue positivo para los marcadores CD3, CD5 y CD4. Todos los pacientes recibieron diferentes tratamientos en función del estadio de su enfermedad. Uno de ellos falleció de shock séptico y el resto presentó respuestas parciales y recidivas frecuentes

Folliculotropic mycosis fungoides is a variant of mycosis fungoides characterized by the presence of folliculotropic infiltrates, often with sparing of the epidermis, and preferential involvement of the head and neck. We report our experience with four cases of folliculotropic mycosis fungoides followed in our department in the last years. There are four patients (three men and one woman) aged 45 to 68 years. Clinically the lesions presented as cysts, comedones, follicular papules and plaques with follicular plugging. The histopathological study showed a peri and intrafollicular infiltrate with partial or total sparing of the epidermis. This infiltrate was mainly composed of atypical lymphocytes. Some cystic formations were also observed. Three cases showed mucin deposits and one showed syringotropism. The immunohistochemical analysis was positive for CD3, CD5 and CD4. All patients received different treatments based on the stage of their disease. One of them died of septic shock and the rest showed partial responses and frequent relapses

[Toxic mustard plaster dematitis and phototoxic dematitis after application of bergamot oil]. / Wenn die Natur zurückschlägt.

Two cases that illustrate the risks attendant on the therapeutic use of natural medications by laypersons are reported. In the first case, the application of a mustard plaster triggered toxic dermatitis. In the second case, a session in a solarium after the external application of bergamot oil resulted in a phototoxic reaction.

Eosinophilic pustular folliculitis: a comprehensive review of treatment options.

Eosinophilic pustular folliculitis (EPF), also known as Ofuji disease, is a disease that manifests with follicular papules or pustules. Its variants include a classic type that occurs most commonly in Japan, an HIV-associated type, an infantile type, a type that occurs on the palms and soles, a rare medication-associated variant, and a rare neoplasia-associated variant.A wide range of medications has been used to treat EPF. Topical corticosteroids are the first-line treatment option for EPF. Topical tacrolimus seems to be useful initial therapy as well. Oral indometacin (50-75 mg/day) is an effective treatment of classic EPF although it can induce peptic ulcers. For treatment of HIV-associated EPF when topical corticosteroids and indometacin do not work, various other treatments should be considered. These treatment options include cetirizine 20-40 mg/day, metronidazole 250 mg three times a day, itraconazole starting at a dosage of 200 mg/day and increasing to 300-400 mg/day, and topical permethrin. If these treatments do not work phototherapy with UVB is the 'gold standard' of treatment and is often curative. Treatments with less certain risk-benefit ratios but with some efficacy include PUVA (psoralen + UVA) photochemotherapy, oral corticosteroids, synthetic retinoids (i.e. isotretinoin 1 mg/kg/day), and acitretin (0.5 mg/kg/day), oral cyclosporine (ciclosporine) 5 mg/kg/day, interferon (IFN)-alpha-2b, and IFNgamma. Minocycline 100mg twice daily and dapsone 50-100mg twice daily have been used with some effect. The use of highly active antiretroviral therapy for HIV has resulted in the amelioration of EPF as CD4 cell counts rise above 250/mm(3). The diversity of clinical presentations and affected populations make it seem that EPF is a reaction pattern as much as a disease and that therapy should be tailored to the variant of EPF and the underlying etiology.

The medical and surgical therapy of pseudofolliculitis barbae.

Pseudofolliculitis barbae (PFB) is a common, chronic, inflammatory skin disorder seen mainly in individuals with curly hair. This condition is seen most frequently in black men who shave their beards but may also be seen in women of all races who wax or shave the axillary and pubic skin. The etiology of PFB is multifactorial, and heretofore a cure has been considered impossible for those desiring a clean-shaven face. The following article serves to discuss the current medical and surgical therapies available for this condition. Medical treatments for this condition include various combinations of topical antibiotics, corticosteroids, and retinoids. In the surgical arena, laser therapy has revolutionized the treatment of PFB and has enabled cure for the first time for those plagued by this disorder and for whom a beardless face is acceptable.

Foliculitis de pelos en penacho / Tufted hair folliculitis

La foliculitis en penacho (tufted hair folliculitis), fue descrita por Smith & Sanderson en 1978 como un proceso inflamatorio exudativo, crónico y poco frecuente, localizado en los folículos del cuero cabelludo. Los pelos así afectados se agrupan en grupos a modo de penacho reuniéndose de 10 a 15 elementos pilosos. Irregularmente distribuidos, estos elementos forman placas inflamatorias levemente supurantes que terminan con una alopecia cicatricial irreversible. El aspecto clínico es muy peculiar y distinto a otras formas patogénicas generadoras de alopecia. En esta entidad al comienzo se desarrollan placas eritematosas y edematosas con pústulas y exudación, a la que también se añaden costras y fina descamación. Su evolución tiende a la fibrosis y al desarrollo de una placa alopécica cicatricial. Se comunica el caso de un varón de 34 años de edad que consultó por la presencia de una placa de estas características en el vertex del cuero cabelludo. Se comenta su diagnosis, evolución, y respuesta al tratamiento con isotretinoina y cloxacilina oral (AU)

Citrobacter koseri in scalp folliculitis.

Gram-negative folliculitis, an uncommon condition, is most often seen in older patients who have acne and who either have received prolonged courses of antibiotic therapy or have used antibacterial cleansers that selectively inhibit gram-positive organisms. Citrobacter infections are uncommon, and dermatologists seldom encounter them. In the past, these infections occurred in hospitals, particularly in neonatal intensive care units. Bacteremias also occur in elderly or immunocompromised patients. In this article, we present a case of Citrobacter koseri scalp folliculitis in an otherwise healthy patient.

Eosinophilic pustular folliculitis (Ofuji's disease): indomethacin as a first choice of treatment.

Eosinophilic pustular folliculitis (EPF) is characterized by erythematous patches of large follicular papules and pustules involving mainly the face. Although various treatments have been attempted for EPF, including systemic and topical steroid, diaphenylsulphone, colchicine, minocycline as well as UVB phototherapy, there is no consensus on the first choice of treatment. We report a typical case and summarize 25 patients with EPF treated in our hospital between 1978 and 1998. Indomethacin was most frequently used (12/25) and showed clinical improvement in the majority of the cases (11/12). The effect of indomethacin was usually observed within 1--2 weeks after initiation of treatment. Decrease of peripheral blood eosinophils accompanied the clinical improvement. Thus, indomethacin should be considered as a first choice of treatment for EPF.

Oncotaxia inflamatoria en lesiones de foliculitis de un paciente con leucemia mieloide aguda / Inflammatory oncotaxis in folliculitis lesions of a patient with acute myelogenous leukemia

Un varón de 68 años diagnosticado de leucemia aguda mieloide presentó lesiones cutáneas de foliculitis. Histológicamente se encontró una foliculitis neutrofílica junto con células blásticas perifoliculares. Las lesiones cutáneas desaparecieron tras un tratamiento antibiótico, mientras que la leucemia empeoraba pese al tratamiento quimioterápico (AU)

Therapy of difficult cases of canine pyoderma with marbofloxacin: a report of 39 dogs.

Thirty-nine dogs with severe and/or recurrent lesions of pyoderma were treated with marbofloxacin at an average dosage of 2.12 mg/kg bodyweight, once daily, for time periods varing from 10 to 213 days. Forty-seven strains of bacteria, isolated from 34 cultures, were tested for sensitivity to various antibiotics. At day 0, no resistance to marbofloxacin was found, but one refractory case, a strain of Staphylococcus intermedius resistant to marbofloxacin, was cultured at day 28. Thirty-three dogs (84.6 per cent) showed an excellent response (cure), one (2.6 per cent) a clear improvement and one (2.6 per cent) a smaller improvement, while the remaining four dogs showed no response after 11 to 60 days. Fifteen dogs (45.5 per cent) relapsed over the follow-up period of three to 191 days, but none of the dogs in the study exhibited any adverse effects.