New hope for rare scalp disease: biologics aim to stop painful flares and hair loss

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Patients ≥ 18-year-old and \< 65-year-old * Presenting with FD confirmed in all cases by at least one compatible histopathology (present or past) * All patients should have a basal FD-IGA score at 3 or 4 and should have received in the previous 2 years at least two lines of antibiotics (first line : at least 3 months doxy/lymecycline (doxycycline 200 mg/day or at least 2 weeks, then 100 mg/day in the following weeks, or lymecycline 300 mg/day for at least 2 weeks, then 150 mg/day in the following weeks) ; second line : Rifampicin/clindamycin 10 weeks (classic regimen for FD) or, in case of contraindication or unaivailability of one or both of these drugs, other antibiotics prescribed for at least 3 weeks alone or in combination (list of antibiotics). * Normal chest x-ray less than 3 months old on the day of inclusion * Individuals affiliated to a social security regimen * Individuals able to understand and express himself/herself in French * Individuals able to participate and to follow up during the study period * Written informed consent from the patient The diagnosis of Folliculitis Decalvans must have been validated collectively as part of care with at least one FD expert. Exclusion Criteria: * Patients with a history of cardiac ischaemia * Moderate to severe heart failure (NYHA classes III/IV) As the whole treatment duration will only be 6 months, the risk of baricitinib-related SAEs will be minimized according to the recent PRAC from the EMA by excluding: * Patients at increased risk of major cardio-vascular problem, * Patients heavy smokers (25 cig/day), * Current or past history of malignancy, with the exception of non-melanoma skin cancer excised and cured more than five years before baseline, per investigator assessment. * Morbid obesity: BMI \> 40 * Individuals with known positive HIV tests and any immunosuppressive condition or drugs. * Hypersensitivity to the active substance or to any of the excipients: Adalimumab, Ustekinumab, Baricitinib (see SmPC) * Patient who has already received one of the treatments evaluated (Adalimumab, Ustekinumab, Baricitinib). * Patient with renal insufficiency (creatinine clearance \< 60 mL/min) * Coexisting inflammatory facial dermatosis such as acne fulminans, hidradenitis suppurativa * Active tuberculosis or other severe infections such as sepsis and opportunistic infections * Women who are pregnant or are breast-feeding, or are of childbearing age who have not used or do not plan to use acceptable birth control measures * Individuals under a measure of legal protection or unable to consent * Participation in another interventional study involving human participants or in the exclusion period at the end of a previous study involving human participants, if applicable.