Tuesday, December 02, 2008

Scalp Folliculitis in a Patient on Chemotherapy

HPI: This 55 yo woman has had a folliculitis of her scalp for the past 2 - 3 weeks. She is receiving taxol and carboplatinum every three weeks for ovarian cancer and has had two infusions thus far. This eruption began after the second infusion.

O/E: Alopecia secondary to chemotherapy. Scattered over the scalp are erythematous papules and pustules. There are no other lesions other than on the scalp.

Clinical Photos:




Lab: Bacterial culture obtained.

Pathology: Can consider biopsy

Diagnosis: Folliculitis. Probably related to Taxol.

Discussion: A Medline search found one reference to Taxol and folliculitis. This was a case report of two men with folliculitis of the bearded areas and chests after Taxol infusions. Folliculitis is also reported in women on Taxol, but there is no literature available on the subject.

Reason Presented: I discussed her findings with her oncologist who said he sees this picture frequently. It's peculair that there are no case reports. Folliculitis can be bacterial, sterile, fungal or even eosinophilic pustular folliculitis. A biopsy might help. In the absence of guidelines, I started the patient on doxycycline 100 mg. bid. If anyone has seen and treated a similar patient, I would appreciate your insights and recommendations.

8 comments:

  1. Dr. Ben BarankinDecember 04, 2008

    I like Doxy 50mg bid with food. Otherwise, would consider Accutane 10mg/day. I also like compounding mixtures like Loprox lotion 1:1 Clindamycin 2% lotion with 2.5% HC powder applied bid; this way, most of your bases are covered.

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  2. Diferential is bacterial folliculitis (? Staph) versus Malassezia. Prior to therapy, bacterial C&S of a pustule, KOH for yeast forms (or biopsy looking for same) would have been helpful.

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  3. Dear Sir
    Looking at the photographs , I was thinking of three possibilities
    1.malassesia folliculitis
    2. neutrophilic eccrine hidradenitis
    3.eosinophilic folliculitis.
    I believe a biopsy would help us in clinching the diagnosis and subsequently managing
    regards
    Dr Manish Pahwa
    MD DNB MNAMS (India)
    drmanishpahwa@gmail.com

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  4. I find that chronic pruritic folliculitis of the parietal and occipital scalp in the otherwise reasonably healthy senior & elderly population to be one of the most frustrating and poorly studied clinical entities that I deal with.

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  5. This is folliculitis.Moreover, isolating organism from the culture would have yeilded better picture.We cannot rule out the possibility of cutaneous side effect of taxol leading to this condition.
    In addition to oral antibiotics, can we not give a trial of local broad spectrum anti-biotic ointment ?


    Shardul Poudyal
    Denver, colorado

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  6. "Anonymous said...
    I find that chronic pruritic folliculitis of the parietal and occipital scalp in the otherwise reasonably healthy senior & elderly population to be one of the most frustrating and poorly studied clinical entities that I deal with.
    December 05, 2008"

    I would like to lend my full support to this statement. This is an undefined clinical disorder that deserves systematic study.

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  7. I wish someone would launch a study of this. I am a perimenopausal woman who developed chronic pruritic folliculitis of the scalp at age 50. My derm seems to not know what to do with me. She seems to just want to throw stuff at the problem, antibiotics, loprox, without researching the cause. If this is such a widespread problem, it deserves a decent study. The itchiness is horrible.

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  8. I am a 33 yr old female that just finished 8 rounds of gemzar and 4 rounds of taxitier. I developed foliculitius after having 3 gemzar infusions and one taxitier infusion. The doctor gave me Bactrim 800mg twice daily for 7 days. I washed my head daily and swiped it over with alcohol at bedtime and anytime I picked at it. It worked nicely. I have had it come back twice now. I am hoping that once my own immune system is back to 100% it will go away for good.

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