Folliculitis Decalvans

Condition Name: Folliculitis decalvans

Definition: Folliculitis decalvans is a chronic inflammatory disorder that primarily affects hair follicles, leading to scarring alopecia. It is characterized by recurrent pustules and crusts around hair follicles, eventually causing permanent hair loss in the affected areas.

Etiology: The etiology of folliculitis decalvans is not fully understood, but it is believed to involve bacterial infection, particularly with Staphylococcus aureus, combined with an abnormal immune response.

Epidemiology: Folliculitis decalvans is relatively rare and typically affects adults, with a slight male predominance. The exact prevalence is not well documented.

Signs: Clinically, it presents with tufted folliculitis, where multiple hairs emerge from a single follicular opening surrounded by inflammation, along with recurrent pustules and crusts on the scalp.

Symptoms: Symptoms include itching, pain, and the presence of pustules and crusts on the scalp.

Differentials: Conditions such as dissecting cellulitis, lichen planopilaris, and acne keloidalis nuchae should be considered.

Diagnosis: Diagnosis is based on clinical examination, patient history, and, if needed, biopsy to confirm the presence of inflammation and scarring around hair follicles.

Treatment: Treatment focuses on controlling infection and inflammation to prevent further hair loss. Topical and systemic antibiotics, such as clindamycin and rifampicin, are commonly used. Additionally, anti-inflammatory medications like corticosteroids and immunosuppressive agents may be prescribed. Early intervention is crucial to manage symptoms and slow the progression of scarring.

References:

●       Scheinfeld, N. (2003). “Folliculitis decalvans: A review of the literature.” American Journal of Clinical Dermatology, 4(6), 369-374. doi:10.2165/00128071-200304060-00003

●       Otberg, N., & Shapiro, J. (2008). “Diagnosis and management of primary cicatricial alopecia: Part II. Treatment.” Journal of the American Academy of Dermatology, 59(1), 1-22. doi:10.1016/j.jaad.2008.01.072