ZusammenfassungHintergrundFolliculitis decalvans (FD) ist eine primäre neutrophile vernarbende Alopezie, die häufig zu irreversiblem Haarverlust führt. Daten zu Epidemiologie, klinischen Merkmalen, ...Folgen und prognostischen Faktoren sind nur eingeschränkt verfügbar.ZielDie Beurteilung einer Patientenkohorte mit FD sowie die Charakterisierung schwerer Krankheitsverläufe und prognostischer Faktoren, die eine Remission verhindern.Patienten und MethodenDiese retrospektive Kohortenstudie umfasste 192 Patienten, bei denen zwischen 2010 und 2020 an einem tertiären Zentrum eine FD diagnostiziert und die mindestens sechs Monate nachverfolgt wurden.ErgebnisseDie Diagnose wurde im Mittel um 22,2 (± 29,7) Monate verzögert gestellt. Komorbide Erkrankungen mit Okklusion der Haarfollikel waren häufig. In 45,6% der Fälle waren Bakterienkulturen positiv, am häufigsten mit Staphylococcus (S.) aureus. Schwere Krankheitsverläufe waren mit komorbider Hidradenitis suppurativa und positiver Bakterienkultur, insbesondere S. aureus, assoziiert. Bei 50,7% der Patienten kam es zu vollständiger Remission: Bei 32% innerhalb der ersten sechs Monate der Behandlung und bei 18,7% während der Nachkontrolle. Rezidive waren häufig. Negative Prognosefaktoren bezüglich der Remission waren jüngeres Alter und positive Bakterienkultur.SchlussfolgerungenEs besteht Bedarf hinsichtlich der Ausbildung von Dermatologen, um die Diagnoseverzögerung zu reduzieren. Das Screening von FD‐Patienten auf komorbide Hidradenitis suppurativa und Bakterienkulturen sind wichtig für die Behandlungsplanung.
Eosinophilic pustular folliculitis (EPF) is a non-infectious inflammatory dermatosis of unknown etiology that principally affects the hair follicles. There are three variants of EPF: (i) classic EPF; ...(ii) immunosuppression-associated EPF, which is subdivided into HIV-associated (IS/HIV) and non-HIV-associated (IS/non-HIV); and (iii) infancy-associated EPF. Oral indomethacin is efficacious, especially for classic EPF. No comprehensive information on the efficacies of other medical management regimens is currently available. In this study, we surveyed regimens for EPF that were described in articles published between 1965 and 2013. In total, there were 1171 regimens; 874, 137, 45 and 115 of which were applied to classic, IS/HIV, IS/non-HIV and infancy-associated EPF, respectively. Classic EPF was preferentially treated with oral indomethacin with efficacy of 84% whereas topical steroids were preferred for IS/HIV, IS/non-HIV and infancy-associated EPF with efficacy of 47%, 73% and 82%, respectively. Other regimens such as oral Sairei-to (a Chinese-Japanese herbal medicine), diaminodiphenyl sulfone, cyclosporin and topical tacrolimus were effective for indomethacin-resistant cases. Although the preclusion of direct comparison among cases was one limitation, this study provides a dataset that is applicable to the construction of therapeutic algorithms for EPF.
Malassezia folliculitis (MalF) mimics acne vulgaris and bacterial folliculitis in clinical presentations. The role of Gram staining in rapid diagnosis of MalF has not been well studied. In our study, ...32 patients were included to investigate the utility of Gram staining for MalF diagnosis. The final diagnoses of MalF were determined according to clinical presentation, pathological result and treatment response to antifungal agents. Our results show that the sensitivity and specificity of Gram staining are 84.6% and 100%, respectively. In conclusion, Gram staining is a rapid, non-invasive, sensitive and specific method for MalF diagnosis.
Pityrosporum folliculitis is an under-recognized eruption of the face and upper portion of the trunk that may be confused with, or occur simultaneously with, acne vulgaris.
We sought to characterize ...risk factors for Pityrosporum folliculitis, its clinical presentation, and its response to treatment.
A retrospective chart review was performed on all patients age 0 to 21 years seen at our facility from 2010 to 2015 with Pityrosporum folliculitis confirmed by a potassium hydroxide preparation.
Of 110 qualifying patients, more than 75% had acne that had recently been treated with antibiotics, and when recorded, 65% reported pruritus. Clinical examination demonstrated numerous 1- to 2-mm monomorphic papules and pustules that were typically on the forehead extending into the hairline and on the upper portion of the back. The most common treatment was ketoconazole shampoo, which led to improvement or resolution in most cases. Some patients required oral azole antifungals.
This study was retrospective and relied on providers describing and interpreting the clinical findings and potassium hydroxide preparations. No standard grading system was used.
Unlike classic acne vulgaris, Pityrosporum folliculitis was more common after antibiotic use. It presented as fine monomorphic, pruritic papules and pustules along the hairline and on the upper portion of the back, and it improved with topical or oral azole antifungal therapy.
Baricitinib, an oral selective Janus kinase 1 and 2 inhibitor, effectively reduced disease severity in moderate to severe atopic dermatitis (AD) in 2 phase 3 monotherapy studies.
To assess the ...efficacy and safety of 4 mg and 2 mg of baricitinib in combination with background topical corticosteroid (TCS) therapy in adults with moderate to severe AD who previously had an inadequate response to TCS therapy.
This double-blind, placebo-controlled, phase 3 randomized clinical trial, BREEZE-AD7 (Study of Baricitinib LY3009104 in Combination With Topical Corticosteroids in Adults With Moderate to Severe Atopic Dermatitis) was conducted from November 16, 2018, to August 22, 2019, at 68 centers across 10 countries in Asia, Australia, Europe, and South America. Patients 18 years or older with moderate to severe AD and an inadequate response to TCSs were included. After completing the study, patients were followed up for up to 4 weeks or enrolled in a long-term extension study.
Patients were randomly assigned (1:1:1) to receive 2 mg of baricitinib once daily (n = 109), 4 mg of baricitinib once daily (n = 111), or placebo (n = 109) for 16 weeks. The use of low-to-moderate potency TCSs was allowed.
The primary end point was the proportion of patients achieving a validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD) score of 0 (clear) or 1 (almost clear), with a 2-point or greater improvement from baseline at week 16.
Among 329 patients (mean SD age, 33.8 12.4 years; 216 66% male), at week 16, a vIGA-AD score of 0 (clear) or 1 (almost clear) was achieved by 34 patients (31%) receiving 4 mg of baricitinib and 26 (24%) receiving 2 mg of baricitinib compared with 16 (15%) receiving placebo (odds ratio vs placebo, 2.8 95% CI, 1.4-5.6; P = .004 for the 4-mg group; 1.9 95% CI, 0.9-3.9; P = .08 for the 2-mg group). Treatment-emergent adverse events were reported in 64 of 111 patients (58%) in the 4-mg group, 61 of 109 patients (56%) in the 2-mg group, and 41 of 108 patients (38%) in the placebo group. Serious adverse events were reported in 4 patients (4%) in the 4-mg group, 2 (2%) in the 2-mg group, and 4 (4%) in the placebo group. The most common adverse events were nasopharyngitis, upper respiratory tract infections, and folliculitis.
A dose of 4 mg of baricitinib in combination with background TCS therapy significantly improved the signs and symptoms of moderate to severe AD, with a safety profile consistent with previous studies of baricitinib in AD.
ClinicalTrials.gov Identifier: NCT03733301.
Pityrosporum folliculitis (PF) is a fungal acneiform disease of the hair follicles that often presents with pruritic papules and pustules on the upper body and face
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This condition is commonly ...mistaken for acne vulgaris and can be distinguished from bacterial acne by the presence of fungal spores in the follicular lumen
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Although studies have been performed to describe PF in cohorts, little work has been done to aggregate these data. Thus, the goal of this review is to describe the clinical characteristics and treatment outcomes of PF in immunocompetent patients. PubMed, Web of Science, and Embase were searched using the terms “Pityrosporum folliculitis” or “Malassezia folliculitis.” All cohorts reporting PF characteristics in patients classified as immunocompetent were reviewed. A total of 15 studies were included. Majority of patients were male (64%) with the average age of presentation of 24.26 years. The most common locations of lesions were the chest (70%) and back/shoulders (69.2%). Pruritus was reported by the majority of patients (71.7%). Additionally, 40.5% of patients reported a history of unsuccessful treatment regimens. Treatment was most successful with an oral antifungal (92%), followed by a topical antifungal (81.6%). In conclusion, majority of patients with PF were younger males. Many patients were primarily treated incorrectly, suggesting the importance of proper diagnosis. PF may be distinguishable from acne vulgaris by the presence of pruritus or suggested when a new acneiform eruption develops following antibiotic therapy or immunosuppression. When properly diagnosed, majority of cases of PF achieve complete response with oral or topical antifungals.
Background
Superficial bacterial folliculitis (SBF) is usually caused by Staphylococcus pseudintermedius and routinely treated with systemic antimicrobial agents. Infection is a consequence of ...reduced immunity associated with alterations of the skin barrier and underlying diseases that may be difficult to diagnose and resolve; thus, SBF is frequently recurrent and repeated treatment is necessary. The emergence of multiresistant bacteria, particularly meticillin‐resistant S. pseudintermedius (MRSP), has focused attention on the need for optimal management of SBF.
Objectives
Provision of an internationally available resource guiding practitioners in the diagnosis, treatment and prevention of SBF.
Development of the guidelines
The guidelines were developed by the Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases, with consultation and advice from diplomates of the American and European Colleges of Veterinary Dermatology. They describe optimal methods for the diagnosis and management of SBF, including isolation of the causative organism, antimicrobial susceptibility testing, selection of antimicrobial drugs, therapeutic protocols and advice on infection control. Guidance is given for topical and systemic modalities, including approaches suitable for MRSP. Systemic drugs are classified in three tiers. Tier one drugs are used when diagnosis is clear cut and risk factors for antimicrobial drug resistance are not present. Otherwise, tier two drugs are used and antimicrobial susceptibility tests are mandatory. Tier three includes drugs reserved for highly resistant infections; their use is strongly discouraged and, when necessary, they should be used in consultation with specialists.
Conclusions and clinical importance
Optimal management of SBF will improve antimicrobial use and reduce selection of MRSP and other multidrug‐resistant bacteria affecting animal and human health.
Résumé
Contexte
La folliculite bactérienne superficielle (SBF) est généralement due à Staphylococcus pseudintermedius et traitée avec des agents antimicrobiens systémiques. L'infection est la conséquence d'une baisse de l'immunité associée à des altérations de la barrière cutanée et de maladies sous‐jacentes qui peuvent être difficiles à diagnostiquer et à résoudre; ainsi, la SBF est fréquemment récidivante et des traitements répétés sont nécessaires. L'émergence de bactéries multirésistantes, en particulier S. pseudintermedius résistante à la méticilline (MRSP) a attiré l'attention sur le besoin d'une gestion optimale de la SBF.
Objectifs
Fournir un guide de recommandations international disponible pour les praticiens pour le diagnostic, le traitement et la prévention de la SBF.
Développement des recommandations
Les recommandations ont été développées par le groupe de travail des recommandations antimicrobiennes de l'ISCAID (International Society for Companion Animal Infectious Diseases) avec la collaboration des diplômés des collèges américain et européen de dermatologie vétérinaire. Ils ont décrit les méthodes optimales de diagnostic et de gestion de la SBF, y compris l'isolement de l'organisme incriminé, les tests de sensibilité antimicrobiens, le choix de la molécule antimicrobienne, les protocoles thérapeutiques et les conseils sur le contrôle de l'infection. Une conduite est donnée sur les voies systémiques et topiques ainsi que les approches appropriées pour MRSP. Les molécules systémiques sont classées en trois groupes. Le premier groupe est utilisé quand le diagnostic est évident et les facteurs de risque pour la résistance antimicrobienne est absente. Sinon, les médicaments du deuxième groupe sont utilisés et des tests de sensibilité antimicrobienne sont nécessaires. Le troisième groupe inclus les molécules réservées pour les infections hautement résistantes, leur utilisation est fortement déconseillée et si nécessaire, elles doivent être utilisées en concertation avec des spécialistes.
Conclusions et importance clinique
La gestion optimale e SBF doit améliorer l'usage des antimicrobiens et diminuer la sélection des MRSP et d'autres bactéries multirésistantes affectant l'animal et la santé humaine.
Resumen
Introducción
la foliculitis superficial bacteriana (SBF) esta generalmente causada por Staphylococcus pseudintermedius y de forma rutinaria tratada con antimicrobianos sistémicos. La infección es consecuencia de la reducida inmunidad asociada con alteraciones de la barrera de la piel y debido a enfermedades primarias que pueden dificultar el diagnostico y el tratamiento; así pues SBF es con frecuencia recidivante y se necesitan tratamientos repetidos. La aparición de multiresistencia bacteriana, particularmente S. pseudintermedius resistente a meticilina (MRSP), ha centrado la atención en la necesidad de un manejo optimo de la SBF.
Objetivos
la provisión de un recurso disponible a nivel internacional que guíe a veterinarios en el diagnostico, tratamiento y prevención de SBF.
Desarrollo de las directrices
las directrices fueron desarrolladas por el Grupo de Trabajo de Directrices Antimicrobianas de la Sociedad Internacional de Enfermedades Infecciosas de Pequeños Animales, consultando y recibiendo consejos de diplomados de los colegios Americano y Europeo de Dermatología Veterinaria. Estas directrices describen los métodos óptimos para el diagnostico y manejo de SBF, incluyendo aislamiento del agente causal, pruebas de susceptibilidad antimicrobiana, selección de fármacos antimicrobianos, protocolos terapéuticos y consejos para el control de la infección. Se aportan directrices para las modalidades de tratamiento tópico y sistémico, incluyendo pautas adecuadas para MRSP. Los fármacos sistémicos se clasifican en tres niveles. Los fármacos del nivel uno se usarían cuando el diagnóstico es claro y no existen factores de riesgo para el desarrollo de resistencia antimicrobiana. En caso contrario, se utilizarían fármacos del nivel dos y son obligatorios el cultivo y pruebas de susceptibilidad. En el nivel tres se incluyen fármacos reservados para infecciones altamente resistentes; su uso no es recomendable y cuando sean necesarios, deben utilizarse tras consulta con un especialista.
Conclusiones e importancia clínica
el manejo optimo de SBF mejorará el uso de antimicrobianos y reducirá la selección de MRSP y otras bacterias multiresistentes que pueden afectar a la salud humana y animal.
Zusammenfassung
Hintergrund
Die superfizielle bakterielle Follikulitis (SBF) wird üblicherweise von Staphylococcus pseudintermedius verursacht und routinemäßig mit systemischen Antibiotika behandelt. Eine Infektion ist die Konsequenz einer reduzierten Immunität, die mit Änderungen der Hautbarriere und zugrundeliegender Erkrankungen, deren Diagnose und Heilung manchmal schwierig sind, einhergeht; daher kehrt die SBF häufig wieder und eine Behandlung ist wiederholt nötig. Durch das Aufkommen von multiresistenten Bakterien, vor allem Methicillin‐resistentem S. pseudintermedius (MRSP), konzentriert sich die Aufmerksamkeit auf den Bedarf einer optimalen Behandlung der SBF.
Ziele
Bereitstellung einer international verfügbaren Quelle, die PraktikerInnen bei der Diagnose, der Behandlung und der Vorbeugung einer SBF unterstützt.
Entwicklung der Richtlinien
Die Richtlinien wurden von der Antimicrobial Guidelines Working Group der International Society for Companion Animal Infectious Diseases entwickelt, unter Beratung und mit Empfehlungen durch Diplomates der American und European Colleges für Veterinärdermatologie. Sie beschreiben optimale Methoden zur Diagnose und für das Management der SBF, die Folgendes beinhalten: Isolierung der verursachenden Keime, Kultur und Antibiogramme, Auswahl der antimikrobiellen Wirkstoffe, therapeutische Protokolle und Empfehlungen bezüglich Infektionskontrolle. Es werden Richtlinien erstellt für topische und systemische Modalitäten, die auch eine passende Herangehensweise für einen MRSP beinhalten. Die systemischen Wirkstoffe werden in drei Stufen klassifiziert. Die Wirkstoffe der Klasse eins werden eingesetzt, wenn die Diagnose eindeutig ist und keine Risikofaktoren für eine antimikrobielle Multiresistenz bestehen. Ansonsten werden Wirkstoffe der Stufe zwei verwendet, wobei Kultur und Antibiogramm obligatorisch durchgeführt werden sollten. Die Wirkstoffe der Stufe drei beinhalten Medikamente für hochresistente Infektionen; von ihrer Verwendung wird strengstens abgeraten und wenn nötig, sollte ihr Einsatz mit Spezialisten besprochen werden.
Schlussfolgerungen und klinische Bedeutung
Ein optimales Management von SBF wird die Verwendung von antimikrobiellen Wirkstoffen verbessern und die Selektion von MRSP und anderen multiresistenten Bakterien, die die tierische und die menschliche Gesundheit beeinträchtigen, reduzieren.
Background – Superficial bacterial folliculitis (SBF) is usually caused by Staphylococcus pseudintermedius and routinely treated with systemic antimicrobial agents. Infection is a consequence of reduced immunity associated with alterations of the skin barrier and underlying diseases that may be difficult to diagnose and resolve; thus, SBF is frequently recurrent and repeated treatment is necessary. The emergence of multiresistant bacteria, particularly meticillin‐resistant S. pseudintermedius (MRSP), has focused attention on the need for optimal management of SBF. Objectives – Provision of an internationally available resource guiding practitioners in the diagnosis, treatment and prevention of SBF. Conclusions and clinical importance – Optimal management of SBF will improve antimicrobial use and reduce selection of MRSP and other multidrug‐resistant bacteria affecting animal and human health.
Hematologic‐associated eosinophilic pustular folliculitis is a subtype of eosinophilic pustular folliculitis (EPF) which develops in patients with underlying hematological malignancies after ...treatment with chemotherapy, bone marrow transplant (BMT), or stem cell transplant (SCT). Few cases of hematological‐associated EPF have been reported in pediatric patients. Skin biopsy is considered the gold standard for diagnosis. We describe a case in which Wright staining of a pustule smear for eosinophils provided data to rapidly support a clinical diagnosis of hematologic‐associated EPF.
Folliculitis decalvans is a chronic inflammatory skin disease leading to scarring alopecia. Management of this disabling disease is difficult and no treatment is currently approved. Current knowledge ...regarding the pathogenesis of folliculitis decalvans suggests the benefit of using anti-tumour necrosis factor-α. This pilot study aimed to evaluate the clinical efficacy of anti-tumour necrosis factor-α for management of folliculitis decalvans. A single-centre retrospective pilot study included patients with refractory folliculitis decalvans treated by tumour necrosis factor-α inhibitors. An Investigator's Global Assessment (IGA) score was designed and validated to assess the efficacy of the therapy. Response to treatment was considered good to excellent when an IGA ≤ 2 was obtained at month 12. Eleven patients were included, with a mean time from diagnosis of folliculitis decalvans to the introduction of infliximab (n = 9) or adalimumab (n = 2) of 8.55 ± 1.26 years. Nine patients had failed on at least 2 lines of systemic therapies before starting anti-tumour necrosis factor-α. The median IGA score at baseline was 3. At the end of follow-up, 5 patients were considered responders. Overall, the safety profile of anti-tumour necrosis factor-α was good. The results suggest that the clinical benefit of anti-tumour necrosis factor-α is obtained after at least 6 months of treatment. However, further prospective studies are needed to confirm these results.
Folliculitis decalvans is a rare inflammatory scalp disorder. The present paper gives a practical approach to diagnosis and patient management and reviews possible pathogenetic factors and treatment ...options. Folliculitis decalvans is classified as primary neutrophilic cicatricial alopecia and predominantly occurs in middle‐aged adults. Staphylococcus aureus and a deficient host immune response seem to play an important role in the development of this disfiguring scalp disease. Lesions occur mainly in the vertex and occipital area. Clinically, the lesions present with follicular pustules, lack of ostia, diffuse and perifollicular erythema, follicular tufting, and, oftentimes, hemorrhagic crusts and erosions. Histology displays a mainly neutrophilic inflammatory infiltrate in early lesions and additionally lymphocytes and plasma cells in advanced lesions. Treatment is focused on the eradication of S. aureus anti‐inflammatory agents.
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