Among patients with folliculitis decalvans (FD) for whom conventional therapies have not been successful, treatment with adalimumab alone has some success, which confirms previous investigation findings, according to study data reported in the Journal of the American Academy of Dermatology.
Development of the disease is not fully understood, making treatment problematic. “Staphylococcus aureus is frequently cultured from typical FD affected hair follicles and its eradication is one of the major goals of treatment with antibiotics as the first line option,” the researchers noted. Treatment resistance occurs with the onset of bacterial biofilms resulting from Gram negative bacteria. Recurrences can happen, and alternative treatments become necessary.
The investigators conducted an observational case series study of 23 patients treated with adalimumab after antibiotics had failed despite most of the patients testing positive for Staphylococcus aureus.
Patients received adalimumab 160 mg injection at baseline, 80 mg injection at week 2 and every other week following. Mild gastro-intestinal adverse events were reported by 2 patients. Treatment (8±6.65 months; range 6-24 months) resulted in improvement (a minimum of decrease in the inflammatory progression, no additional growth, and no new foci) for all patients, although 2 patients discontinued treatment due to unsatisfactory improvement which may have been related to mixed culture swabs of Staphylococcus aureus and Gram-negative bacteria.
Study results matched previous findings, in which “adalimumab reports the higher, even if limited, number of successfully treated FD patients,” it was written. Despite the limited success, researchers believe adalimumab treatment for FD is, “probably due to the fact that tumor necrosis factor (TNF) is an inflammatory cytokine commonly encountered in neutrophilic dermatoses and TNF-α inhibitors have been used with success in many of them. An extensive follow up is however needed because not enough data exist about possible flare ups during treatment and long-standing remission of the disease.” This study group is still being treated as previous studies suggest recurrence follows treatment stoppage.
Iorizzo M, Starace M, Vano-Galvan S, et al. Refractory folliculitis decalvans treated with adalimumab: A case series of 23 patients. J Am Acad Dermatol. Published online March 1, 2022. doi:10.1016/j.jaad.2022.02.044