Folliculitis decalvans. Possibilities of combined therapy with 308 nm UVB: clinical cases

Folliculitis decalvans is a rare neutrophilic cicatricial alopecia of the scalp. As it is a progressive inflammatory disease characterized by a gradual increase in the area of inflamed follicles with the formation of areas of cicatricial alopecia in the outcome. The most common clinical manifestations of folliculitis decalvans are follicular pustules, polytrichia, erosions and hemorrhagic crusts. At later stages dermal fibrosis predominates. The exact cause of folliculitis decalvans is not fully understood, but it is believed that Staphylococcus aureus may play a role in its development. Current knowledge regarding the pathogenesis of folliculitis decalvans suggests three stages including hyperactivation of innate immunity, bacterial infection and fibrosis as an outcome of the disease. The most frequently used treatments are topical steroids, topical antibiotics, and systemic antibacterial drugs, systemic isotretinoin, topical anti-inflammatory drugs, genetically engineered biological drugs, laser and surgical treatment, but all of the above methods usually result in only temporary remission. Phototherapy is an efficient therapy for a variety of skin diseases. We hypothesize that wavelengths in a range 308 nm eradicate bacteria more effectively than antibiotics in monotherapy. The combination of ultraviolet-B 308 nm, oral antibiotics, topical combined glucocorticoid drugs, topical and systemic application of bacteriophages, sensitives to the identified flora to the drugs have demonstrated an excellent tolerance and great outcomes in a series of cases.