Folliculitis Decalvans: Causes, Symptoms, and Treatment

Folliculitis decalvans is a chronic inflammatory disorder primarily affecting the scalp, characterized by inflammation and scarring of hair follicles. While relatively rare, it can result in permanent hair loss and scarring. This condition may also affect other hair-bearing regions of the body, such as the beard, armpits, or pubic area, although it is most commonly observed on the scalp. Despite its significant impact on affected individuals, Folliculitis decalvans is not contagious, although recent evidence suggests a potential hereditary predisposition.

What is Folliculitis Decalvans?

Folliculitis decalvans manifests as a progressive disorder marked by inflammation and scarring of the scalp’s hair follicles. The condition initiates inflammation within the follicles, leading to purulent discharge, redness, and swelling. Over time, this inflammation results in the destruction of follicles and subsequent permanent hair loss. The chronic inflammatory process often culminates in cicatricial alopecia, characterized by baldness with scarring. Both men and women can be affected by Folliculitis decalvans, with onset typically occurring during adolescence for men and later in life, around the age of 40, for women.

Signs and Symptoms of Folliculitis Decalvans

Folliculitis decalvans is typified by follicular scarring and the presence of pustules, which may contain purulent material. Patients commonly report sensations of itching, pain, and a burning sensation in affected areas. Additionally, crusting around pustules and spontaneous bleeding may occur in many cases. The condition often begins in the occipital and vertex regions of the scalp, initially presenting as localized patches of follicular scarring before potentially progressing to widespread cicatricial alopecia. Tufted folliculitis, characterized by multiple hairs sprouting from a single follicle, is another characteristic feature. These tufts of hair are shed over time, leading to follicle destruction and scarring. However, some individuals may not experience any specific symptoms at all.

Treatment of Folliculitis Decalvans

Treatment for Folliculitis decalvans aims to manage symptoms and slow disease progression. Oral antibiotics and topical antimicrobials are commonly prescribed to control infection and inflammation. In severe cases, oral corticosteroids or immunosuppressants may be necessary to suppress the immune response and reduce inflammation. Additionally, intralesional steroid injections may be administered directly into affected areas to target inflammation. Unfortunately, there is no definitive cure for Folliculitis decalvans, and treatment primarily focuses on symptom management and prevention of further scarring and hair loss. Close monitoring by a dermatologist or healthcare professional is essential to tailor treatment approaches to individual patient needs and minimize disease impact.

Treatment of Folliculitis Decalvans

Treating Folliculitis decalvans can be challenging due to the unknown primary cause of the condition. However, it is believed that Staphylococcus aureus bacteria, along with immune system dysfunction and an inflammatory response, contribute to its development. Treatment primarily focuses on eliminating Staphylococcus aureus and managing inflammation.

• • Antibiotic Therapy: Antibiotics are often prescribed to target Staphylococcus aureus. Topical antiseptics and oral antibiotics, such as rifampicin combined with clindamycin, have shown effectiveness in controlling the condition. Topical antibiotics, when used in conjunction with intranasal therapy, have also yielded positive results.
  • Corticosteroids: Corticosteroids are commonly used to provide symptomatic relief and reduce inflammation associated with Folliculitis decalvans. They may be administered orally or applied topically to affected areas.
  • Oral Therapy: Oral medications like dapsone and zinc sulfate have shown some positive effects in managing Folliculitis decalvans. These medications help in controlling inflammation and suppressing the immune response associated with the condition.

Causes of Folliculitis Decalvans

The exact cause of Folliculitis decalvans remains unknown. However, Staphylococcus aureus bacteria are often found in the pustular lesions associated with the condition, suggesting their potential role in its pathogenesis. It is unclear whether Staphylococcus aureus colonization simply exacerbates the infection or if it actively triggers an abnormal immune response. Additionally, genetic predisposition may play a role in the development of Folliculitis decalvans, as evidenced by familial investigations.

Appearance of Folliculitis Decalvans

Folliculitis decalvans typically presents as round bald patches surrounded by pustules, crusting, and sometimes erosions. These patches commonly occur at the vertex and occipital regions of the scalp but can affect other hair-bearing areas as well. Initially, the affected area may appear red and swollen, with the development of follicular lesions that progress to pus-filled pustules. Crusting forms around these pustules, eventually detaching along with the hair. Spontaneous bleeding from these crusts may also occur. As the condition progresses, the affected areas develop pinkish or whitish bald patches due to scarring and hair loss. Tufting hair, where multiple hairs grow from a single follicle, is another characteristic feature of Folliculitis decalvans. Overall, the condition progresses chronically and possesses a distinct appearance.

How is Folliculitis decalvans diagnosed?

Folliculitis decalvans can be diagnosed on the basis of dermatoscopic examination of the scalp. A comprehensive clinical history and examination findings help in diagnosing the disorder. Initially the scalp is examined for scarring and further investigation is done for presence of crusts, pustules and tufted hair. Usually swabs from intact pustules are microscopically examined for the presence of Staphylococcus aureus. Skin scrapings are taken to investigate and rule out fungal infections. Eliminating these other infections is important because often fungal infections like ringworm appear similar to Folliculitis decalvans. Many a times, the dermatologists may carry out more than one biopsy to for diagnosis of Folliculitis decalvans and rule out other types of Alopecia.