Isotretinoin for Folliculitis Decalvans: Good or Very Good?

Folliculitis decalvans: Isotretinoin among the top choices

Folliculitis decalvans is a less common type of scarring alopecia. Dermatologists who treat the condition often choose between antibtioics and isotretinoin when deciding on management strategies. Sometimes both are employed. 

Previous studies have shown the both can be helpful. In some studies, including those by Vano-Galvan the importance of antibiotics was emphasized. In other studies, the benefits of oral isotretinoin were emphasized. 

A new study from Turkey evaluated the benefits of isotretinoin in 39 male patients with folliculitis decalvans. The mean age was 38 years and all received oral isotretinoin for a range of 1-8 months. The dose range in the study was 0.1 to 1.02 mg/kg each day. The authors showed benefit with use of isotretinoin in 82 % of patients. Doses greater than 0.4 mg/kg daily were most helpful.

Conclusion

It's clear that both antibiotics as well as isotretinoin sit at the top of the list of effective treatments for folliculitis decalvans.  While earlier studies emphasized the importance of antibiotics, the benefits of isotretinoin are increasingly clear. 

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Reference

Aksoy B, et al. Isotretinoin treatment for folliculitis decalvans: a retrospective case-series study. Int J Dermatol. 2018.

Tietze JK et al. Oral isotretinoin as the most effective treatment in folliculitis decalvans: a retrospective comparison of different treatment regimens in 28 patients. J Eur Acad Dermatol Venereol. 2015 Feb 24. doi: 10.1111/jdv.13052. 

Vano-Galvan et al. Folliculitis decalvans: a multicentre review of 82 patients. J Eur Acad Dermatol Venereol. 2015 Feb 12.