Paquet P, Piérard G-E
Service de Dermatopathologie, CHU du Sart Tilman, B-4000 Liège, Belgium.
Ann Dermatol Venereol. 2004 Feb;131(2):195-7. doi: 10.1016/s0151-9638(04)93570-3.
Folliculitis decalvans consists of recurrent patchy painful folliculitis of the scalp causing scarring alopecia. The physiopathology of this condition is still unclear, but is likely a manifestation of chronic neutrophilic bacterial folliculitis. Numerous topical and systemic treatments (corticosteroids, antistaphylococcal antibiotics) have been used with variable results. Based on the dapsone antimicrobial activity and its anti-inflammatory action especially directed to the neutrophil metabolism, we treated two patients with severe folliculitis decalvans with this drug.
The patients were treated with dapsone at a daily dose of 75 and 100 mg, respectively for 4 to 6 months. After 1 and 2 months, pustular folliculitis progressively cleared, leaving a residual non inflammatory cicatricial alopecia. When maintaining a dapsone dosage at 25 mg/day no relapse occurred during 3 years and 1 year, respectively. No important adverse effect to dapsone was evidenced. After dapsone withdrawal, a moderate relapse of the disease with pruritus and folliculitis occurred after a few weeks in both cases. The disease relapse rapidly cleared after dapsone reintroduction at a daily dose of 25 mg.
Dapsone at moderate dosage was well tolerated and rapidly effective in treating the two cases of folliculitis decalvans. A long term and low dose (25 mg daily) maintenance treatment avoided disease relapses.
脱发性毛囊炎表现为头皮反复出现片状疼痛性毛囊炎，导致瘢痕性脱发。该病的生理病理学仍不清楚，但可能是慢性嗜中性细菌性毛囊炎的一种表现。许多局部和全身治疗方法（皮质类固醇、抗葡萄球菌抗生素）都曾使用过，效果不一。基于氨苯砜的抗菌活性及其抗炎作用，特别是针对中性粒细胞代谢的作用，我们用该药治疗了两名重度脱发性毛囊炎患者。
两名患者分别接受每日75毫克和100毫克的氨苯砜治疗，持续4至6个月。1个月和2个月后，脓疱性毛囊炎逐渐消退，留下残留的非炎性瘢痕性脱发。当将氨苯砜剂量维持在每日25毫克时，分别在3年和1年内未出现复发。未发现氨苯砜有重要不良反应。停用氨苯砜后，两例患者在几周后均出现疾病中度复发，伴有瘙痒和毛囊炎。重新引入每日25毫克的氨苯砜后，疾病复发迅速消退。
中等剂量的氨苯砜耐受性良好，对两例脱发性毛囊炎治疗迅速有效。长期低剂量（每日25毫克）维持治疗可避免疾病复发。
