Refractory Folliculitis Decalvans: New Therapeutic Horizons?

Folliculitis decalvans (FD) poses a significant challenge due to treatment resistance and relapses. We report a case of FD refractory to various treatments for 15 years, where initiating adalimumab led to an excellent response. Male patient, 33 years, throughout the 15-year follow-up followed up due to a confirmed diagnosis of FD, underwent several cycles of antibiotics, besides the use of isotretinoin and dapsone, at different times, both without clinical improvement. Understanding that the diagnosis of FD falls within the spectrum of hidradenitis suppurativa (HS), we decided to started adalimumab with a dosage regimen specific to HS and we used the HS physician global assessment (HS-PGA) score to assess the improvement. After 13 weeks, the patient showed significant improvement going from a severe to mild rating by the HS-PGA score. Using a tumor necrosis factor-alpha (TNFα) blocker like adalimumab in treatment may be justified, since is an inflammatory cytokine commonly seen in neutrophilic dermatoses, including FD. The inappropriate cell-mediated immune response in FD leads to increased TNFα levels. However, further studies and broader monitoring of each case are necessary to better understand possible flare-ups during treatment and achieve lasting remission of the disease.