As written in Rook’s Textbook of Dermatology, the treatment of folliculitis decalvans or tufted folliculitis consists of attempts to eradicate Staphylococcus aureus from the scalp.
Prolonged courses of flucloxacilin induce remission, but relapse occurs when the antibiotics are stopped. For localized areas, topical clindamycin is useful. Tetracyclines are also commonly effective.
Isotretinoin has been used to alter the follicular environment to make it less suitable for Staphylococcus aureus colonization, but it may increase cutaneous carriage of this organism and make the condition worse.
The only treatment shown to induce prolonged remission is rifampicin in a dosage of 300 mg twice daily. This should be given in combination with other antibiotics to prevent emergence of resistant organisms (i.e. new resistant generations of Staphylococcus aureus).
Drugs commonly used in combination include clindamycin 300 mg twice daily, fucidic acid 150 mg three times daily, ciprofloxacin, doxycycline and clarithromycin.
Tufting may be reduced by measures directed at reducing the scale, such as the use of tar shampoos and topical keratolytics.
Scarring alopecia is irreversible. A trial of oral steroids or anti-malarials may be considered to assess the potential for regrowth. Surgical correction of small areas can be considered once the underlying disorder has burned out. This can be done either by follicle transplantation or excision of the area.
What is rifampicin
Rifampicin (also referred to as rifampin) belongs to the group of ansamycin antibiotics. It is a semi-synthetic derivative of rifamycin B produced by bacteria Streptomyces mediterranei.
Rifampicin has bactericidal activity in vitro against slow and intermittently growing M
tuberculosis organisms, atypical mycobacteria and mycobacteria that cause leprosy.
Rifampicin exhibits in vitro activity against most strains of the following microorganisms:
- Staphylococcus aureus (including Methicillin-Resistant S. aureus/MRSA)
- Staphylococcus epidermidis
- Haemophilus influenzae
- Mycobacterium leprae
- Neisseria meningitidis
- Neisseria gonorrhoeae
- Legionella spp.
Rifampicin inhibits DNA-dependent RNA polymerase activity in susceptible microorganisms. Specifically, it interacts with bacterial RNA polymerase.
Prior to initiation of therapy, appropriate bacteriologic cultures should be obtained to confirm the susceptibility of the organism to rifampicin (in vitro susceptibility tests) and they should be repeated throughout therapy to monitor the response to treatment. Since resistance can emerge rapidly, susceptibility tests should be performed in the event of persistent positive cultures during the course of treatment. If test results show resistance to rifampicin and the patient is not responding to therapy, the drug regimen should be modified.
Organisms resistant to rifampicin are likely to be resistant to other rifamycins.
Patients should take rifampicin either 1 hour before or 2 hours after a meal with a full glass of water. Rifampicin is readily absorbed from the gastrointestinal tract. Absorption of rifampicin is reduced by about 30% when the drug is ingested with food.
Rifampicin is being metabolized in liver and has been shown to produce liver dysfunction. In patients with impaired liver function, careful monitoring of liver function, especially SGPT/ALT and SGOT/AST should be carried out prior to therapy and then every 2 to 4 weeks during therapy. If signs of hepatocellular damage occur, rifampicin should be withdrawn.
Rifampicin may produce a reddish coloration of the urine, sweat, sputum, and tears.
Adults treated with rifampicin should have baseline measurements of hepatic enzymes, bilirubin, serum creatinine, a complete blood count, and a platelet count (or estimate).
Note: This is a very brief information on rifampicin. Read the full information here.
In the US the most common brand name for rifampicin is:
- RIFADIN® (rifampin capsules USP) for oral administration and contain 150 mg or 300 mg rifampin per capsule, and
- RIFADIN® IV (rifampin for injection USP) for intravenous administration and contains 600 mg rifampin.
To find out under what brand name is rifampicin prescribed in your country click here.