Folliculitis decalvans is a relatively rare inflammatory disease of the scalp, which is characterized by inflamed hair follicles and leads to permanent hair loss, baldness and scarring. Both men and women can develop this slowly progressive and difficult to treat disease. The cause of the condition is unknown as of 2023. Experts suspect that there is an autoimmune disease. Folliculitis decalvans is a difficult skin disease to treat and there is no cure for the disease. However, the symptoms can be alleviated with adequate treatment. The bald spots on the scalp are permanent and regrowth of the hair is not possible.
- What is decalvans folliculitis?
- Who can get this condition?
- Cause of folliculitis decalvans
- Symptoms: inflamed hair follicles and hair loss
- Examination and diagnosis
- Physical examination and tissue examination
- Differential diagnosis
- Treatment of decalvans folliculitis
- Long-term oral antibiotic treatment
- Local corticosteroids
- Oral isotretinoin
- Prognosis
- Prevention
What is decalvans folliculitis?
Folliculitis decalvans is an inflammatory disease of the scalp, characterized by inflamed hair follicles. This inflammation of the scalp causes permanent hair loss and unsightly scarring. The inflammation can spread to other hair follicles and spread. The inflammatory disease is mainly seen on the crown.
Who can get this condition?
Both men and women can get this condition. In men it often starts in adolescence and in women often when they are thirty years old or older.
Cause of folliculitis decalvans
The cause of decalvans folliculitis is not known. Experts suspect that folliculitis decalvans is an autoimmune disease, in which the body’s immune system ‘attacks’ its own cells and causes inflammation of the hair follicles. The bacterium Staphylococcus aureus may also play a (minor) role in the development of this disease.
Symptoms: inflamed hair follicles and hair loss
Folliculitis decalvans can manifest itself in any hairy part of the body, such as the armpits, beard region, pubic area, lower legs, thighs and arms. Nevertheless, it is mainly a condition of the hairy scalp, with the crown as the preferred location. Usually one or more round or oval spots with thinner hair implants and scalp infections are visible. There are also often small pimples around the hair follicles and this condition appears to cause multiple hairs to grow from one hair follicle, giving it a ‘doll hair appearance’. As a result of the inflammation, scarring of the hair follicles occurs, leading to permanent hair loss and bald spots. The edge around the bald spots is usually painful. Furthermore, flakes stick to the scalp and hair. This condition is often very psychologically stressful for the person in question.
Examination and diagnosis
Physical examination and tissue examination
In order to make a correct diagnosis, in addition to examining the skin, microscopic tissue examination (a biopsy) is also necessary. In addition, culture under sterile conditions of the contents of an intact pustule is recommended. The bacterium Staphylococcus aureus is usually cultured from the pustules.
Differential diagnosis
The differential diagnosis is:
- dissecting folliculitis (perifolliculitis capitis abscedens et suffodiens)
- pseudopelade of Brocq
- cicatricial alopecia nno
- central centrifugal cicatricial alopecia (CCCA)
- bacterial folliculitis
- acne necrotica
- acne keloidalis
- lichen planopilaris
- chronic discoid lupus erythematosus (CDLE)
- keloid folliculitis (acne keloidalis nuchae)
- alopecia atrophicans or cicatricial alopecia (collective name for forms of baldness that involve scarring)
- hidradenitis suppurativa
Treatment of decalvans folliculitis
Folliculitis decalvans is often an inflammatory disease that is difficult to treat. There is no treatment that will cure this condition with certainty. Initially, it is important to control the disease by calming the skin. This can be done through the following treatments.
Long-term oral antibiotic treatment
Antibiotics from the tetracycline group are usually the first choice in the treatment of decalvans folliculitis. The results are variable and vary per person. The combination of clindamycin 300 mg twice daily + rifampicin 300 mg twice daily can have a beneficial effect. This is the same combination that is prescribed for severe, treatment-resistant hidradenitis suppurativa.
Local corticosteroids
In severe cases, antibiotic treatment can be combined with local corticosteroids.
Oral isotretinoin
If antibiotics have insufficient effect, treatment with isotretinoin can be considered, which suppresses the condition. Oral isotretinoin can lead to long-term remission in some patients.
Prognosis
The medicines suppress the condition, but do not cure it. After stopping the medication, the symptoms may return or flare up. Over time, folliculitis decalvans may disappear on its own, but the hair loss that has occurred will not recover.
Prevention
As of 2023, there are no known preventive measures for decalvans folliculitis.
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