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Keratosis Follicularis Spinulosa Decalvans

KFSD is an inherited inflammatory scalp disorder.

Keratosis follicularis spinulosa decalvans (KFSD) is an inflammatory scalp disorder typified by hair follicles clogged with hardened keratin plugs and progressively worsening cicatricial hair loss. An inherited condition, it usually becomes evident during childhood. 22 Hair loss resembles patchy alopecia and may include eyebrows and eyelashes. Scalp hair loss is usually more prevalent in the vertex area. To prevent scarring hair loss, treatment should begin in childhood. Pustule flare-ups often become infected with bacteria (such as Staphylococcus aureus) and need to be treated.23, 145

Treatments for KFSD

Although therapeutic options exist, KFSD is difficult to treat and outcomes are mixed. 23 Those that have shown at least some response are:

  • Intralesional steroid shots (triamcinolone acetonide, 3 mg/mL) 23
  • Oral antibiotics (although some suggest they are ineffective) 22, 145
  • Systemic drugs (e.g., dapsone) 145
  • Systemic retinoids (some claim isotretinoin is ineffective, but it achieved lasting remission in at least one case with 12 weeks of 0.5 mg/day) 23, 145
  • Topical retinoids 22
  • Topical steroids (mid to high potency) 22-23, 145
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