Pentoxifylline and ciprofloxacin in chronic folliculitis of legs

Introduction

Chronic folliculitis of legs has been described mainly in young adult males in India, consisting of profuse eruption of superficial and deep follicular pustules on the thigh and lower legs. These lesions persist for many years and become resistant to treatment. Apart from using conventional antibiotics, PUVAsol, PUVAsol with cotrimoxazole and ciprofloxacin have been tried with varying sucess rates.[1],[2] However, a successful form of thearpy for this frustrating disease is yet to evolve. The xanthine derivative pentoxifylline is a widely used vasoctive drug with clinical efficacy in various microcirculatory disorders and recently its potential use as anti-inflammatory and as immune-modulator drug has gained increasing interest. In the present study, we compared the efficacy of ciprofloxacin and combination of ciprofloxacin and pentoxifylline in this disease.

Materials and Methods

A total 38 clinically diagnosed cases of superficial chronic folliculitis were enrolled in this study. Depending upon the type, number and sites affected, lesions were graded into 4 categories. They had received no topical or systemic treatment for at least 4 weeks before entering the study. The patients were randomly allocated to treatment groups equally. The group I (19 patients) were given ciprofloxacin twice daily for 2 weeks along with placebo thrice daily for 4 weeks. The group II consisting of 19 patients were given pentoxifylline 400mg thrice daily along with ciprofloxacin twice daily for 2 weeks followed by pentoxifylline 400mg thrice daily for another 4 weeks. Clinical improvement was recorded at the end of 2nd week by grading the lesions. Then, the patients were followed at monthly interval for 6 months.

Results

Of the 38 patients enrolled in the study, 18 in group I and 17 in group II were able to be evaluated, whose age ranged from 18 to 39 years (mean age 22.5 years). Both drugs were well tolerated except 1 patient complained of GIT intolerence in form of dyspesia and nausea with pentoxifylline and was withdrawn from study.

In group I, out of 18 patients 12 (66.7%) showed an excellent response i.e. resolution of all the lesions while 3 patients (16.7%) showed good response whereas 3 patients (16.7%) failed to show any clinical improvement. In group II, 15 patients (88.3%) showed excellent improvement, 1 patient (5.9%) showed good response and 1 (5.9%) showed no response.

Relapse of the lesions was seen in 15 out of 18 patients (83.3%) in group I with average remission period of 42.5 days whereas only 3 patients (17.7%) in group II showed relapse after an avergae remission period of 103 days.

Discussion

Pentoxifylline is a methylxanthine derivative with diverese pharmacological properties. Many studies have shown that pentoxifylline decreases neutrophil adherence and aggregation, whereas it incerease polymorphonuclear cell motility and chemotaxis.[3] The mechanism of action is probably multifactorial. Wahba[4] reported prevention of recurrences of intractable chronic furunculosis with pentoxifylline. Apart from its broad spectrum antibacterial activity, recent investigations with fluoroquinolone ciprofloxacin suggest a possible synergism with pentoxifylline in the inhibtion of TNF-α. This formed the basis for the present study. Although the combination of ciprofloxacin and pentoxifylline was more effective than the combination of ciprofloxacin and placebo in the intial response, but much more significant was the prevention of reccurence in patient treated with pentoxifylline. The reccurence rate in group II was 17.7% as compared to 83.3% in group I. Further clinical trials should be undertaken to evaluate the optimum duration of pentoxifylline therapy in prevention of reccurence of this frustrating condition[5].