Instructions
- Advise patient to avoid friction from clothes and close haircuts
- Do not wear any kind of head-dress or head gear that causes mechanical irritation of the posterior hairline
- Treatment should be started early before signifcant scarring has occurred.
- Bacterial culture should be obtained from any site with oozing or drainage, followed by treatment with the appropriate systemic antibiotic.
Medical treatment
For active disease
Topical treatment
- Tretinoin gel : Twice-daily
- -a Mid- to high-potency corticosteroid
- Antimicrobial washes
- Intralesional steroids ( Triamcinolone acetonide (5–20 mg/ml) for large papules and nodules.
- Intralesional 5-fluorouracil
systemic treatment
- Oral tetracyclines
- Clindamycin
- Rifampicin.
- Systemic isotretinoin
Maintenance therapy
Combination of topical retinoids + benzoyl peroxide gel or wash
Intermittent topical corticosteroids.
Physical treatment
- Punch excision with a hair transplant trephine followed by either a primary closure or healing by second intention , 50:50 mixture of 2% lidocaine (with epinephrine) and triamcinolone acetonide (40 mg/ml) can be used for local anesthesia in order to help prevent recurrence,One week after suture removal, the excision sites are injected with triamcinolone acetonide (40 mg/ml), and this can be performed three more times at 3-week intervals.
- Excision with primary closure is the treatment of choice of plaques of 1- 1.5 cm in vertical diameter .
- CO2 laser excision and postoperative triamcinolone injections (10–40 mg/ml) every 3 weeks for four sessions, starting 2 weeks after the laser procedure.
- Diode laser has been used for clearing papular lesions
- Laser hair removal
- Cryotherapy : The area is frozen for 20 seconds, allowed to thaw, and is then frozen again 1 minute later.