What is the treatment for erythromelanosis follicularis faciei et colli?

Treatment for Erythromelanosis Follicularis Faciei et Colli (EFFC)

The most effective treatment approach for erythromelanosis follicularis faciei et colli includes topical vasoconstrictors, retinoids, sun protection, and oral tetracyclines for the follicular component, with treatment selection based on symptom severity and predominant features. 1

Understanding EFFC

Erythromelanosis follicularis faciei et colli is a rare condition characterized by a clinical triad:

• Well-demarcated erythema
• Hyperpigmentation
• Follicular papules on the face and neck 2, 3

The condition typically affects the frontal, malar, temporal, and preauricular regions, often extending to the neck 2. While previously thought to primarily affect males, recent evidence shows it can occur in both genders 4.

First-Line Treatment Options

Topical Treatments

• Topical vasoconstrictors (first choice):

  • Compounded midodrine 0.2%
  • Alternatives: phenylephrine, oxymetazoline 0.05%, timolol maleate 0.5%, or brimonidine tartrate 0.33% 1

• Topical retinoids (for follicular component):

  • Must be used under dermatologist supervision
  • Helps with follicular plugging 1

• Mild corticosteroids:

  • Hydrocortisone 1% cream for inflammatory component
  • Limit use to avoid complications like skin atrophy 1

Sun Protection (Essential)

• Daily broad-spectrum sunscreen (SPF 30+) with zinc oxide or titanium dioxide
• Sun avoidance and protective clothing including hats
• These measures prevent worsening of hyperpigmentation 1

Second-Line Treatment Options

Systemic Treatments

• Oral tetracyclines for prominent follicular component:

  • Doxycycline or minocycline for anti-inflammatory effects 1

• For severe pruritus (if present):

  • Gabapentin (100-300 mg TID)
  • Pregabalin (starting at 75 mg BID)
  • Antihistamines for mild cases 1

Skincare Recommendations

Daily Care

• Use gentle pH-neutral soaps and shampoos with tepid water
• Apply hypoallergenic moisturizing creams daily
• Pat skin dry rather than rubbing after washing
• Avoid greasy creams that might worsen folliculitis 1

Avoid Irritants

• Excessive washing with hot water
• Over-the-counter anti-acne medications
• Chemical irritants
• Manipulation of skin 1

Treatment Algorithm Based on Severity

Body Surface Area (BSA) Affected	Recommended Treatment
<10%	Topical vasoconstrictors + antihistamines
10-30%	Add neuromodulators (gabapentin/pregabalin)
>30%	Consider systemic treatments + immediate dermatology referral

Monitoring and Follow-up

• Reassess after 2 weeks of treatment
• Monitor for signs of secondary infection (yellow crusting, pustules)
• Consider topical or oral antibiotics if infection is suspected 1

When to Refer to Dermatology

• Severe cases
• Cases unresponsive to first-line treatment after 4 weeks
• Cases with suspected secondary infection 1

Special Considerations

• EFFC is often associated with keratosis pilaris on the upper arms and thighs 5
• The condition may be underdiagnosed due to lack of awareness or its generally asymptomatic nature 5
• Treatment should focus on both the erythema and follicular components for best results