WHAT IS FOLLICULITIS DECALVANS?
Folliculitis Decalvans (FD) is a chronic inflammatory scalp condition that destroys hair follicles, leading to permanent hair loss, therefore we call this a scarring type of hair loss.
It belongs to a group of conditions called neutrophilic scarring alopecias. FD typically starts on the crown or vertex of the scalp but can also affect the hairline, beard, eyebrows, nape, and, in rare cases, body hair such as underarms, thighs, and pubic hair.
It often begins with pustules or pimple like eruptions, redness, itching, burning, or tenderness. You might notice crusting, scaling, tufted hairs (several hairs emerging from one follicle), or even blood on the pillow after sleeping.
While it can affect both men and women in young or middle adulthood, it may be slightly more common in men. It occurs in all ethnicities but can be underdiagnosed in African descent individuals due to similarities with other scalp conditions. A family history of inflammatory or scarring scalp disorders may increase the risk.
Folliculitis decalvans is a hair loss disorder which is commonly misdiagnosed. It is a chronic, scarring condition that can lead to permanent hair loss if not treated early.
It affects both men and women and often begins in the crown area with pimple-like bumps, pustules, redness and sometimes bleeding. Over time, this results in progressive patchy hair loss.
Any hair bearing area can be affected such as the scalp, beard, underam and public area.
People with this condition may experience significant itching, burning, and pain in the affected areas. Blood may be noticed on pillows after sleeping.
Multiple hairs can be seen coming out of a single follicle, giving a tufted appearance.
The exact cause is unknown, but in some cases the bacteria Staphylococcus aureus may play a role in triggering inflammation.
HOW IS FOLLICULITIS DECALVANS DIAGNOSED?
Our expert trichologist, Donia Maria Messeh, will perform a thorough evaluation and clinical examination. In many cases, additional tests are carried out to confirm the diagnosis.
Scalp or nasal may be taken to check for bacterial colonization, especially Staphylococcus aureus. These steps help distinguish folliculitis decalvans from other scalp conditions.
A scalp biopsy is often performed to confirm the diagnosis.
WHAT TREATMENT OPTIONS ARE AVAILABLE?
Treatment for folliculitis decalvans is mainly centered around antibacterial therapies and anti-inflammatory approaches. Common options include:
- Oral antibiotics such as cephalexin, doxycycline, clindamycin, or rifampin
- Isotretinoin or dapsone for severe or resistant cases
- Topical antibiotics and corticosteroid lotions or gels
- Antibacterial shampoos containing chlorhexidine or benzoyl peroxide
- Intralesional corticosteroid injections
WHAT ARE MY NEXT STEPS?
Book a consultation with our expert trichologist Donia Maria Messeh, who will evaluate your condition and offer treatment options going forward. Click the link below to start the process.