Vol 8, No 2 (2022)
Review paper
Published online: 2022-06-06
Page views 4710
Article views/downloads 55
Get Citation

Connect on Social Media

Connect on Social Media

Role of Staphylococcus aureus in the pathogenesis of folliculitis decalvans

Aleksandra Jedlecka1, Małgorzata Grabarczyk1, Kinga Kubicka-Szweda1, Aleksandra Siegmund1, Bartosz Miziołek23, Beata Bergler-Czop2
Forum Dermatologicum 2022;8(2):86-88.

Abstract

Folliculitis decalvans (FD) is an inflammatory cicatricial alopecia. Its aetiology remains unclear but an imbalance of skin microbiota seems to play a special role in the pathogenesis. The normal subepidermal microbiota resides in hair follicles and protects from opportunistic infections. Previously Staphylococcus aureus (S. aureus) was postulated to play the main role in the pathogenesis of the disease, but recent findings show it is rather opportunistic than a specific pathogen in FD. Staphylococcus aureus colonizing FD does not seem to be more virulent than one isolated from the general population, however, only a partial response to standard anti-staphylococcal antibiotic treatment suggests rather gram-negative aetiology. Antibiotic therapy may prove effective to reduce bacterial load below the threshold that triggers the immune system, but the microbiota found in FD after antibiotic treatment is not entirely restored to normal. Unbalanced microbiota with the reservoir of commensal and opportunistic bacteria in hair follicles may stoke unspecific responses of the immune system, therefore causing chronic inflammation.

Article available in PDF format

Add to basket: 49.00 PLN

Aready have access?

References

  1. Quinquaud E. Folliculite epilante et destructive des regions velues. Bull Mem Soc Hop Paris. 1888; 5: 395–398.
  2. Otberg N, Kang H, Alzolibani AA, et al. Folliculitis decalvans. Dermatol Ther. 2008; 21(4): 238–244.
  3. Tan E, Martinka M, Ball N, et al. Primary cicatricial alopecias: clinicopathology of 112 cases. J Am Acad Dermatol. 2004; 50(1): 25–32.
  4. Villablanca S, Fischer C, García-García SC, et al. Primary Scarring Alopecia: Clinical-Pathological Review of 72 Cases and Review of the Literature. Skin Appendage Disord. 2017; 3(3): 132–143.
  5. Bogg A. Folliculitis decalvans. Acta Derm Venereol (Stockh). 1963; 43: 14–24.
  6. Jahns AC, Lundskog B, Nosek D, et al. Microbiology of folliculitis decalvans: a histological study of 37 patients. J Eur Acad Dermatol Venereol. 2015; 29(5): 1025–1026.
  7. Uchiyama M, Harada K, Tobita R, et al. Histopathologic and dermoscopic features of 42 cases of folliculitis decalvans: A case series. J Am Acad Dermatol. 2021; 85(5): 1185–1193.
  8. Miguel-Gómez L, Rodrigues-Barata AR, Molina-Ruiz A, et al. Folliculitis decalvans: Effectiveness of therapies and prognostic factors in a multicenter series of 60 patients with long-term follow-up. J Am Acad Dermatol. 2018; 79(5): 878–883.
  9. Powell J, Dawber RP. Folliculitis decalvans and tufted folliculitis are specific infective diseases that may lead to scarring, but are not a subset of central centrifugal scarring alopecia. Arch Dermatol. 2001; 137(3): 373–374.
  10. Matard B, Donay JL, Resche-Rigon M, et al. Folliculitis decalvans is characterized by a persistent, abnormal subepidermal microbiota. Exp Dermatol. 2020; 29(3): 295–298.
  11. Rogolsky M. Nonenteric toxins of Staphylococcus aureus. Microbiol Rev. 1979; 43(3): 320–360.
  12. Marrack P, Kappler J. The staphylococcal enterotoxins and their relatives. Science. 1990; 248(4956): 705–711.
  13. Matard B, Meylheuc T, Briandet R, et al. First evidence of bacterial biofilms in the anaerobe part of scalp hair follicles: a pilot comparative study in folliculitis decalvans. J Eur Acad Dermatol Venereol. 2013; 27(7): 853–860.
  14. Blaskovich MAT, Elliott AG, Kavanagh AM, et al. In vitro Antimicrobial Activity of Acne Drugs Against Skin-Associated Bacteria. Sci Rep. 2019; 9(1): 14658.
  15. Rambhia PH, Conic RRZ, Murad A, et al. Updates in therapeutics for folliculitis decalvans: A systematic review with evidence-based analysis. J Am Acad Dermatol. 2019; 80(3): 794–801.e1.
  16. Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report World Health Organization 2021. https://apps.who.int/iris/rest/bitstreams/1350455/retrieve (10.01.2022).
  17. Vañó-Galván S, Molina-Ruiz AM, Fernández-Crehuet P, et al. Folliculitis decalvans: a multicentre review of 82 patients. J Eur Acad Dermatol Venereol. 2015; 29(9): 1750–1757.
  18. Asfour L, Trautt E, Harries MJ. Folliculitis Decalvans in the Era of Antibiotic Resistance: Microbiology and Antibiotic Sensitivities in a Tertiary Hair Clinic. Int J Trichology. 2020; 12(4): 193–194.
  19. Tietze JK, Heppt MV, von Preußen A, et al. Oral isotretinoin as the most effective treatment in folliculitis decalvans: a retrospective comparison of different treatment regimens in 28 patients. J Eur Acad Dermatol Venereol. 2015; 29(9): 1816–1821.
  20. Samrao A, Mirmirani P. Gram-negative infections in patients with folliculitis decalvans: a subset of patients requiring alternative treatment. Dermatol Online J. 2020; 26(2).