Pulsed Azithromycin for Folliculitis Decalvans

Pulsed therapy for Folliculitis decalvans

Folliculitis decalvans is a type of scarring alopecia and causes permanent hair loss. Affected individuals develop crops of papules, and pustules. The most effective treatment options are antibiotics and isotretinoin. 


Pulsed Therapy for FD

In an effort to reduce side effects from the daily use of a drug, "pulsed therapy" is frequently used for some medications. Pulsed therapy refers to delivery of a medication for short periods of time (i.e. the 'pulse') followed by periods of time whereby the patient does not receive any medications at all.  Pulsed therapy is common with oral steroids, oral anti-fungal medications as well as some antibiotics.

A new study has examined the possibility of using pulses of azithromycin to treat folliculitis decalvans.  The researchers studied 19 patients with mean age 27 years. Treatment was with azithromycin 500 mg per day for 3 consecutive days and repeated every 2 weeks. The severity of the disease was evaluated before treatment and after 1, 3 and 6 months.  

The study showed that azithromycin reduced the number of lesions as well as the disease activity. 



Pulsed azithromycin is among the antibiotic options for FD. Pulses of azithromycin are sometimes used as treatments for acne so this method of using azithromycin in a pulsed manner is not new. Side effects of azithromycin should be carefully review before starting. 

Download our Azithromycin Handout for Patients



Andre MC et al. Effective Treatment of Folliculitis Decalvans: Azithromycin in Monotherapy. Hair Therapy and Transplantation. 

Antonio JR et al. Azithromycin pulses in the treatment of inflammatory and pustular acne: efficacy, tolerability and safety.J Dermal Treatment 2008;19(4):210-5. doi: 10.1080/09546630701881506.

Parsad D et al. Azithromycin monthly pulse vs daily doxycycline in the treatment of acne vulgaris.J Dermatol. 2001 Jan;28(1):1-4.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887

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