Folliculitis Decalvans: Causes, Symptoms, Treatment, Complications

Folliculitis decalvans is a rare condition that leads to inflammation of the hair follicles and scalp. Over time the person notices hair fall and scarring.⁽¹⁾ This condition is known to cause permanent hair loss.

Folliculitis is the inflammation of the hair follicle, which is a bulb-shaped root that anchors hair to the scalp and generates new hair. Bacteria can get trapped in the follicles leading to pus-filled bumps known as pustules.

Folliculitis decalvans is a chronic inflammatory condition that can lead to hair loss. It is believed to occur due to the growth of Staphylococcus aureus bacteria. This bacteria is also normally present on the skin and may be harmless. It can lead to inflammation of the hair follicles and prevent them from growing new hair. After some time the hair falls out leaving scars. This hair loss is also known as alopecia and is categorized as cicatricial alopecia or scarring hair loss.

Folliculitis decalvans is different from folliculitis as along with inflaming the hair follicles it can stop the hair growth.

Folliculitis decalvans can happen to anyone even those in overall good health. This condition is more common in middle-aged men but can affect women as well. It is rare in children and is not contagious.

Folliculitis decalvans may cause itching, inflammation, tenderness, and a tight feeling on the scalp. Some people, may experience no symptoms at all.

The symptoms of folliculitis decalvans include:

• Redness
• Swelling
• Pustules
• Scaling
• Sores
• Tufting of hairs
• Hair loss in this condition occurs in irregular patches.

The alopecia is most noticeable on the scalp. However, it may also occur in the beard, armpits, pubic area, and legs.

To get this condition diagnosed it is important to visit a dermatologist, a doctor who specializes in treating skin and hair conditions. He can use a magnifying glass to see the pustules more clearly. The doctor may also:

• Take a swab of the fluid from the pustule
• Pluck a few hair strands and take skin scrapings
• Perform skin biopsy to confirm the diagnosis

Currently, there is no targeted treatment for folliculitis decalvans. The focus is to provide relief from the symptoms and prevent the condition from getting worse.

There are various treatments. Some may be more effective for certain people than others. A person may pursue a variety of treatments or a combination of two or more approaches.

There are several antibiotics that can be used in the treatment of folliculitis decalvans. A review of various folliculitis decalvan studies found clindamycin and rifampicin to be the most, effective combination of antibiotics to treat this condition.^{(2, 3)} This combination was associated with a remission period of 7.2 months.

In the same study, another combination of doxycycline and azithromycin was found to have a shorter remission period, even after the administration of corticosteroid injections and topical antibiotics.

A corticosteroid injection can be another way to reduce inflammation on the scalp and other areas due to follicular decalvans.

Oral corticosteroids may also be prescribed to help fight inflammation and stop the spread of folliculitis decalvans.

Special light therapies are used to fight skin infections, these are known as photodynamic therapies. It can be effective in treating folliculitis decalvans and also preventing flare-ups.

It is an option for people who have a poor response to other treatment options.

Once the condition is controlled with various medication and therapies a person may think of restoring hair.

A doctor may harvest hair from another healthy part of the body and graft them on the hair. A study done in 2019 suggested that hair transplant conditions can be effective for people with a range of hair conditions.⁽⁴⁾

There are certain home treatments that can be helpful in managing the symptoms at home, for example using antiseptic shampoo. Tar shampoo helpful for scalp psoriasis and similar conditions can also be used for folliculitis decalvans.

Whatever is being used should be confirmed with a dermatologist, so avoid any side effects and prevent the condition from flaring up.

Apart from baldness and scarring, folliculitis decalvans can also cause some serious health concerns.

Squamous cell carcinoma is the most serious complication of folliculitis decalvans.

The emotional and psychological impact is another complication that cannot be diagnosed. It can affect person’s self-esteem.

As there is no treatment for folliculitis decalvans, it is important to get an early diagnosis and treatment to reduce the impact of the condition.