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What is Folliculitis Decalvans?

By Maggie J. Hall
Updated Mar 03, 2024
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Folliculitis decalvans, also referred to as cicatricial alopecia, is an infection-like disorder of the hair follicles that can produce permanent hair loss and scarring. Initiating factors are relatively unknown, though cultures of pus filled pimples, or pustules, surrounding affected follicles generally produce bacterial colonies. Folliculitis treatment depends on the severity of the condition and generally includes oral corticosteroids and antibiotics.

Both men and women can develop folliculitis decalvans anytime from adolescence into middle adulthood, despite being otherwise healthy. The disorder begins with pimple eruptions, which encompass hair follicles. Neutrophilic inflammation eventually follows, brought about by bacterial invasion. In the majority of cases, Staphylococcus aureus colonies are present, but other strains of bacteria might also contribute to the condition. The affected area typically reddens, may swell, and is often itchy or uncomfortable. The pustules usually rupture, exude fluid, then form crusts.

The condition eventually destroys the hair inside of the follicle, leaving a scar and inhibiting future hair growth. The affected area of the scalp frequently resembles the bristles on a hairbrush, as bald patches intermingle with follicles containing multiple hairs. Under these circumstances, the condition might be referred to as tufted folliculitis. At other times, folliculitis decalvans produces larger, more noticeable, rounded or ovoid bald spots. The condition can be self-limiting to one small location or spread extensively to surrounding areas.

In progressive cases, bald, scarred patches of scalp might be visible, surrounded by the active disease process. The densely populated scalp region is typically the most common location for the dermatological disorder, but the condition is not necessarily restricted to the scalp alone. It sometimes develops in obscure places, including beards, armpits, or genitals. Folliculitis decalvans may also occur in the hair follicles of the arms or legs.

Some patients experience complete resolution of the condition without requiring medical intervention. Individuals suffering extensive or particularly bothersome cases of folliculitis decalvans may receive a prescriptions for an oral corticosteroid or a synthetic retinoic acid medication, which generally alleviates inflammation and discomfort. Health care providers or dermatologists might perform culture and sensitivity testing of the lesions when infectious processes appear to contribute or exacerbate the condition. If persons are suspected of carrying a particular bacteria, nasal cavities might also be tested.

Persons found to have extensive bacterial involvement might receive a topical antibiotic ointment, typically applied to the affected areas and possibly the nares. Depending on the severity of the folliculitis decalvans, physicians may also prescribe one or more oral antibiotics for an extended period of time to eliminate the bacteria. This type of intense therapy generally results in complete and long lasting resolution of the disorder.

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Discussion Comments
By heilbrun — On Jun 07, 2011

Does your physician suspect a particular pathogen is contributing to the malady? After identifying the causative bacteria, you and your physician may discuss possible options.

By anon171386 — On Apr 30, 2011

I have being suffering with decalvans of the scalp for about seven years now. I'm 30 years old in July. I have tried tetracycline for some time and that had a stop-start effect. When I was told I had decalvan, I was put on rifampicin and minocycline, but would you believe I collapsed the first night. I was thinking would dapsone be a good bet?

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