Folliculitis Decalvans Treatment
Folliculitis decalvans is a chronic condition that can last many years to decades. Once the hair has been lost due to scarring, regrowth is not possible. The goal of treatment is to prevent further scarring and to diminish the pain and drainage associated with active lesions. I have found that a combination of rifampin 300 mg b.i.d. with cephalexin 500 mg b.i.d. is very beneficial in achieving these goals. I initially treat patients with the antibiotic combination for one month. Most patients experience a marked decrease in disease activity with this treatment. I then have patients continue treatment for one month after the disease has become inactive. The treatment is then discontinued and the patient keeps a diary of disease activity, noting how long it takes for the disease to recur off treatment.
Eventually the patient is able to keep the disease under control by intermittent courses of the antibiotic combination. A typical regimen might be one or two months on the treatment alternating with 3 months off therapy. In my experience, most patients are able to control their disease using this approach. Topical therapy, including steroids and antibiotics, and intralesional steroids have all been ineffective in treating my patients with folliculitis decalvans.