F.F. Ismail 1 , R. Sinclair1,2,3
We report on a 30-year-old lady with a 14-year history of refractory folliculitis decalvans who experienced signiﬁ- cant clinical improvement with the anti-interleukin-17A (IL-17A) antibody secukinumab. She ﬁrst developed the condition at 15 years of age with a small patch of hair loss on the vertex of the scalp which gradually enlarged. Examination revealed a large oval patch of hair loss, with erythema, scaling and crusting.
Previous treatments which had been trialled with minimal improvement included topical and intralesional corticos- teroids, several oral antibiotics, isotretinoin, cyclosporin and tofacitinib.
Secukinumab injections were acquired through compas- sionate supply from the manufacturer in this case. Secuk- inumab 300 mg was administered subcutaneously at weeks 0, 1, 2, 3 and 4 followed by 300 mg every 4 weeks thereafter.
After 4 months of treatment there was signiﬁcant improve- ment in her condition with a reduction in active folliculitis decalvans. Treatment with 4-weekly injections was contin- ued with a sustained response after 7 months. No adverse effects were reported.
Successful treatment of folliculitis decalvans with biologic therapy using the tumour necrosis factor-alpha (TNF-a) inhibitor adalimumab has previously been described in case reports1,2. This case report demonstrates that secuk- inumab may be a potential treatment option for treatment- refractory folliculitis decalvans, although larger studies are needed to support this theory.
1. Shireen F, Sudhakar A. A case of isotretinoin therapy-refractory folliculitis decalvans treated successfully with Biosimilar Adali- mumab (Exemptia). Int J Trichology. 2018 Sept-Oct;10(5):240–
2. Kreutzer K, Effendy I. Therapy-resistant folliculitis decalvans and lichen planopilaris successfully treated with adalimumab. J Dtsch Dermatol Ges. 2014 Jan;12(1):74–76.