Table 1:

Grade 3 Studies with low quality of evidence

Study design	Previous treatment failure	No. of patients	Treatment regimen	Treatment adverse effects	Treatment outcome	Outcome from ACP grading
1) Retrospective, multicenter review. [Vano-Galvan et al; J Eur Acad DermatolVenereol. 2015; 29(9):1750–57]	Not mentioned	• Total patients: 82 • 52 were men. • Mean age: 35 years. • Severe disease 17(21%) pts.	• Doxycycline (39 pts) for 3–6 months. • Clindamycin and rifampicin (15 pts) for 10 weeks. • Azithromycin (6 pts) 3 times weekly for 3 months	None	• Doxycycline: 90% improvement, remission (mean: 4.8 months). •Clindamycin and rifampicin: 100% improvement, remission (mean: 7.2 months). Azithromycin: 100% improvement, remission (mean: 4.6 months).	Grade 3
2) Retrospective, single center, observational study. [Tietze et al; J Eur Acad Dermatol Venereol 2015; 29(9):1816–21]	Clindamycin, rifampicin, clarithromycin, dapsone,	• Total patients: 28 • 26 were men. • Age range: 19–64 years.	• IST (0.2–0.5mg/kg) for 5–7 months. • Dosage tapered after remission achieved to 10mg 2–3 times weekly in 3 patients. • Follow-up period range: 2 months 15 years	None	• Complete remission with IST in 9 (90%) pts for 4 months – 2 years. 3 (30%) patients required maintenance on low dose IST. • Relapse rates with antimicrobials: clindamycin/rifampicin 8 (80%) pts, clarithromycin 6 (67%) pts, ciprofloxacin or doxycycline 7 (78%) pts, dapsone 4 (57%) pts.	Grade 3
3) Retrospective, single center, observational study. [Bunagan et al; J Cutan Med Surg. 2015; 19(1):45–9]	Not mentioned	• Total patients: 23 • 16 were men. • Follow-up period ranged between 3 months to 13 years.	• ILT + Clobetasol lotion + (either doxycycline 100mg bid, minocycline 100mg bid or tetracycline 500mg bid) (n=10) • Cephalexin + ILT + clobetasol lotion (n=6) • Clindamycin + rifampicin (n=1) • ILT + clobetasol lotion (n=1) • Multiple combinations (cephalexin, minocycline, tetracycline, rifampicin, clindamycin, ciprofloxacin, IST, dapsone) (n=5)	None	•FD in remission in 7/10 (70%) patients, treatment discontinued. FD inactive in 3 (30%) patients with continued treatment. •FD inactive in 6/6 (100%) patients with continued treatment. •FD in remission in 1/1(100%) patient, treatment discontinued. •FD in remission in 1/1 (100%) patient, treatment discontinued. FD under control in 2/5 (40%) patients with continued treatment, FD still active in 3/5 (60%) patients despite treatment.	Grade 3
4) Single center case series, Non-blinded, non-randomized study [Sillani et al; Int J Trichol Jan 2010;2(1):20–3]	Not reported	• Total patients: 13 • 11 were male • Mean age 30.1 range 15–66	• Mild FD - Minocycline 100 mg po twice daily • Moderate FD - Minocycline 100 mg po twice daily + Rifampicin 150—300 mg twice daily. • Adjuvant drugs used included topical fusidic acid or mupirocin, selenium sulfide shampoo, oral compound glycyrrhizin, and zinc gluconate	One patient developed nausea and vertigo from rifampicin	• Mild FD cases (n=8) - Minocycline 100mg bid, for an average of 5.7 weeks was able to clear inflammatory scalp lesions in 7 out of 8 patients, 1 of whom needed two week Acitretin rescue therapy. 1 of 8 exhibited FD relapse after 8 months. •Moderate FD cases - A combination of Minocycline and Rifampicin for an average of 11.7 weeks was effective in treating three patients. Clarithromycin + Rifampicin for average of 10 weeks was also effective in clearing scalp lesions in 2 patients (1 mild FD, and 1 moderate FD). *9 out of 13 patients were partial hair growth responders (<75%)	Grade 3
5), Case series study. [Powell et al; Br J Dermatol.1999;140 (2):328–33]	Flucoxacillin, erythromycin, minocycline.	• Total patients: 18 • 13 were men. • Age range (18–62 years)	• Clindamycin 300mg twice daily and rifampicin 300mg twice daily for 10 weeks.	One patient developed a rash from clindamycin.	• FD in remission for 2–22 months in 10(55.6%) patients after one 10-week course. • FD in remission in 15(83.3%) patients after a further 2–3 10-week course.	Grade 3
6) Retrospective, multicenter review. [Miguel-Gomez et al; J Am Acad Dermatol. 2018; Epub ahead of print.]	Not reported	• Total patients: 60 • 37 were men. • Median 40 • Age range (23–83 years)	• Topical steroids (n=48) • Topical antibiotics (n=37) • Tetracycline (n=36) • Intralesional steroids (n=25) • Rifampicin and clindamycin (n=21) • Oral isotretinoin (n=15) • Photodynamic therapy (n=8) • Oral steroids (n=5) • Azithromycin and dapsone (n=4) • Topical tacrolimus (n=3) •Hydroxychloroquine and minoxidil (n=2)	Epigastralgia, diarrhea, and headache were associated with tetracyclines in four patients. Hypercholes terolemia, arthralgias and epistaxis in 3 pts treated with isotretinoin.	• Tetracyclines used in moderate and severe FD pts (n=36) had a 91% response rate. •In refractory cases, the combination of rifampicin and clindamycin was the most effective with 90.5% response rate, and had longer duration of response at 5 months.	Grade 3
7) Retrospective, case series study.[Aksoy et al; Int J Dermatol. 2018; 57(2):250–253]	Not reported	• Total patients: 39 male • Mean age 37.85 •Range (16–82)	• Oral isotretinoin 0.1–1.02 mg/kg/d for a median duration of 2.5 months (range: 1–8months) • Patients that responded to treatment (n=36) were subgrouped according to daily dose (<0.4 mg/kg and ≥0.4 mg/kg) and duration (<3 mo or ≥3mo)	Hyperlipide mia (35.9%), intractable xerosis (10.3%)	• 36 pts had partial and complete response following isotretinoin treatment • 61.5% of pts had response to IST w/i 1 month. • 66% of pts receiving IST <3 mo relapsed. Pts that received oral IST ≥0.4 mg/kg/day for ≥3 mo had the best response to IST, and 66% did not have disease relapse.	Grade 3