PMC10086126_01
Evolution of the scalp manifestation of the PCAS patient. (A) Typical lesions of PCAS on the scalp, nodules, pustules, and alopecia patches prior to adalimumab and isotretinoin therapy on 17 February 2022. (B) After 1 month of treatment with adalimumab and isotretinoin on 24 March 2022. (C) After 5 months of treatment with adalimumab and isotretinoin on 23 July 2022. (D) After changing the treatment regimen to adalimumab and baricitinib for 4 months on November 20, 2022. PCAS, Perifolliculitis capitis abscedens et suffodiens.
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The interconnecting sinuses of the patient were filled with malodorous pus, and extensive alopecia patches were located in the parietal-occipital scalp (Figure 1A). Furthermore, the alopecia patches were converted from an extensive wide range to scattered sections and the tenderness markedly subsided (Figure 1B). In addition, the skin lesions' improvement seemed to have plateaued (Figure 1C). The lesions painlessly and infrequently leaked a tiny amount of pus after another 2 months of treatment, and most instances of alopecia recovered satisfactorily (Figure 1D).
Important dates, periods, and detailed diagnostic process during the PCAS treatment and follow-up periods. WBC, white blood cells; N, neutrophils; L, Lymphocytes; ESR, erythrocyte sedimentation Rate; CRP, C-reactive protein; TG, triglyceride; TC, total cholesterol.
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Figure 2 shows the entire course of treatment.