Folliculitis Decalvans

Key Points
Scarring condition of the scalp causing hair loss
Consists of Folliculitis of scalp hair follicles, which results in damage and scarring of the follicle and subsequent hair loss

Folliculitis decalvans is a scarring type of alopecia, or hair loss, which typically affects the scalp. The condition initially presents as Folliculitis (swelling, redness, pustules). This results in the follicle being destroyed, causing scarring and hair loss. The condition may be accompanied by itching in the affected area. Follicle destruction is not immediate, so affected areas may be surrounded by areas of previous hair loss, giving the affected area a tufted look. Affected areas may be limited, but in some cases the condition becomes widespread, causing large areas of alopecia and scarring.

The cause of Folliculitis decalvans is not entirely known. There are likely genetic components in many cases which cause follicular occlusion. Some cases are accompanied by a bacterial infection of the follicle, but what role this infection plays in the development of the condition is unclear.

Differential Diagnosis (Other conditions with similar appearance)

Lichen Planopilaris
Acne keloidalis
Dissecting Cellulitis of the scalp
Kerion

Diagnosis
Key Points
Diagnosis based on the characteristic appearance of the affected area
Skin biopsy and bacterial cultures may be performed to confirm diagnosis and rule out other conditions

Folliculitis decalvans is diagnosed based on the characteristic appearance of the affected area. A skin Biopsy and bacterial cultures of lesions may be performed to confirm the diagnosis and rule out similar appearing conditions.

Treatment
Tetracyline derivatives with or without topical steroids
Bacterial culture should be performed to rule out coexisting infection which should be treated based on sensitivities if present

Treatment of the condition typically consists of controlling symptoms through administration of various systemic medications, most often antibiotics (including Tetracycline, Rifampicin, Clindamycin, Fusidic acid, Dicloxacillin, and Ciprofloxacin). Isotretinoin has been shown to have some effectiveness in treatment. In severe cases, corticosteroids may be prescribed in conjunction with other medications.