Reply: Treatment of folliculitis decalvans with photodynamic therapy

Abstract

To the Editor: We would like to thank Burillo-Martinez et al for their interest and critical appraisal of our report on treatment of folliculitis decalvans (FD) with photodynamic therapy (PDT).1Miguel-Gómez L. Vañó-Galván S. Pérez-García B. Carrillo-Gijon R. Jaen-Olasolo P. Treatment of folliculitis decalvans with photodynamic therapy: results in 10 patients.J Am Acad Dermatol. 2015; 72: 1085-1087Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar With respect to their poor results, we think that it may be due to the small number of patients (only 3) who were treated with this therapy. Concomitantly, they represented severe and resistant cases to conventional treatments. However, in our study, 10 patients were treated with PDT, of which 9 (90%) achieved clinical improvement. In addition, they belonged to a wide clinic spectrum, from mild to severe cases, and we obtained better results, with a prolonged duration of response.1Miguel-Gómez L. Vañó-Galván S. Pérez-García B. Carrillo-Gijon R. Jaen-Olasolo P. Treatment of folliculitis decalvans with photodynamic therapy: results in 10 patients.J Am Acad Dermatol. 2015; 72: 1085-1087Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar Nevertheless, relapse was seen in some of our patients, so PDT is not a curative therapy; it would be an option for patients resistant to classical therapies or patients with early relapses requiring continuous oral antibiotics. Regarding the comment about the adverse effects experimented in all their cases during and post-illumination, we agree with Burillo-Martinez et al that PDT is an uncomfortable therapy that may cause local symptoms such as erythema, pain, or burning, but in our experience, all of them are transient, mild, and self-limiting within a few days. We think that we observed less side effects because our protocol consisted of 1 session of PDT at a 4-week interval while Burillo-Martinez et al performed cycles at 4 or 6-week intervals, and each cycle involved 2 treatment sessions 2 weeks apart. FD is often resistant to conventional treatments and even combined therapies, and most patients need to take systemic drugs for prolonged periods.2Ross E.K. Tan E. Shapiro J. Update on primary cicatricial alopecias.J Am Acad Dermatol. 2005; 53: 1-37Abstract Full Text Full Text PDF PubMed Scopus (198) Google Scholar For all that, it is a priority to find therapeutic alternatives to get a prolonged disease-free period and avoid the progression of scarring alopecia. This therapy has low toxicity, and it would be very useful in selected patients.1Miguel-Gómez L. Vañó-Galván S. Pérez-García B. Carrillo-Gijon R. Jaen-Olasolo P. Treatment of folliculitis decalvans with photodynamic therapy: results in 10 patients.J Am Acad Dermatol. 2015; 72: 1085-1087Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar, 3Castaño-Suárez E. Romero-Maté A. Arias-Palomo D. Borbujo J. Photodynamic therapy for the treatment of folliculitis decalvans.Photodermatol Photoimmunol Photomed. 2012; 28: 102-104Crossref PubMed Scopus (17) Google Scholar Clinical trials with an increased number of cases are required to determine the efficacy profile and the factors that would predict the therapeutic response to this therapy. Failure of photodynamic therapy (PDT) in 3 patients with folliculitis decalvansJournal of the American Academy of DermatologyVol. 74Issue 4PreviewTo the Editor: We greatly appreciated the article by Miguel-Gomez et al1 on “Treatment of folliculitis decalvans with photodynamic therapy: results in 10 patients” and we report herein our experience, which is somewhat different. Full-Text PDF