Folliculitis Decalvans: An Overview

Introduction

Folliculitis Decalvans is a condition that causes baldness and scarring. This baldness is caused by Staph A bacteria.The bacteria and the inflammation caused in the hair follicle result in the formation of pustules. This can result in the death of hair follicles followed by preventing new hair growth. Due to a lack of new hair growth, circular bald patches will be formed. This condition is treated using antibiotics and photodynamic therapy. Read the article to know more.

What Is Meant by Folliculitis?

Folliculitis is a common skin condition that is characterized by infection or inflammation of the hair follicle. This condition usually starts as a small bump or acne and can also occur on the face, arms, legs, and back. Severe infection can result in permanent hair loss and scarring. This condition needs to be treated using antibiotics.

What Is Meant by Folliculitis Decalvans?

Folliculitis decalvans is a chronic, neutrophilic inflammation that causes hair loss and scarring. This form of scarring is called cicatricial alopecia. Folliculitis decalvans is caused due to inflammation of the hair follicle.

Who Can Be Affected by Folliculitis Decalvans?

This condition is mostly seen in males during the fourth and fifth decades. Children are usually not affected. No racial difference is seen.

What Are the Clinical Features of Folliculitis Decalvans?

This condition generally affects the scalp and results in hair loss and scarring. In some cases, it can also affect the beard area, axillae, pubic hair, and limbs. The clinical features include:

• Presence of solitary or multiple irregular and atrophic white patches of hair loss and scarring.

• Soft areas of the scalp.

• Presence of follicular pustules and perifollicular crusts.

• Scales and erosions.

• Multiple hair grows from a single hair follicle called tufting.

• Pain, discomfort, and mild itching.

What Is the Causative Factor of Folliculitis Decalvans?

There is no proper causative factor for this condition. The only factor that needs to be considered is Staphylococcus infection which is caused by Stap A where some people can have unusual reactions to this bacteria which is present naturally on the skin and inside the nose. This bacteria is usually harmless, but for some people, it causes continuous inflammation, which destroys the hair follicle, prevents hair growth, and causes scarring. This is a permanent hair loss.

What Are the Symptoms Related to Folliculitis Decalvans?

Some common symptoms are

• Folliculitis decalvans usually occur in the scalp and result in round-shaped bald patches, but very rarely do they occur in other regions.

• Some people will not have symptoms until they notice hair fall, while others can feel their scalp being itchy.

• The scalp can have pustules, which can be painful and tight.

• This condition can cause hair growth in tufts.

How Is Folliculitis Decalvans Diagnosed?

The skin specialist or a dermatologist will initially do a physical examination of the scalp. They may be used as magnifying devices to examine the scalp. To confirm the condition, the doctor may recommend some tests, such as

• A swab test will be done where the fluid-filled pustules will be collected to see for the presence of Staph A bacteria.

• Some strands of hair will be collected along with skin scrapings from the scalp. This is done to rule out ringworm as this condition also causes similar symptoms even though it is a fungal infection.

• A skin biopsy will be performed.

How Is Folliculitis Decalvans Managed?

There is no permanent cure for this condition. The main aim of the treatment is to manage the inflammation and prevent the condition from getting worse. There are many treatment options where a person can pursue two or three to get better results. Some are:

1. Medications:

Oral antibiotics in different combinations can be used which shows good results. Clindamycin and Rifampicin are used as a ten-week course and a combination of Doxycycline and Azithromycin is also recommended.

2. Injections:

Steroid injections given at the affected area can help to manage folliculitis decalvans. Steroid injections will be recommended along with oral or topical antibiotics. Oral corticosteroids are sometimes suggested by the doctor to manage the spread of the condition.

3. Topical Medications:

Topical antibiotics and medicated shampoo are usually recommended. This form of treatment will be effective along with oral antibiotics.

4. Photodynamic Therapy:

When other treatments are not effective, then photodynamic therapy is suggested where special light will be used to manage the condition. In this procedure a chemical will be applied to the scalp and special light will be passed. This chemical will react to the light and destroy the bacteria and cells.

5. Surgery:

Medications and other non-invasive treatment methods are the first lines of treatment for folliculitis decalvans, and once the condition is controlled, the person may consider hair restoration options. A hair transplant will be recommended only if there is no progression of the condition after stopping medication and treatment procedures for some time and no inflammation is recorded in a biopsy.

What Are the Complications Related to Folliculitis Decalvans?

Some common complications related to folliculitis decalvans are

• Permanent progressive hair loss and scarring.

• Psychological effects.

• Squamous cell carcinoma is the most common form of skin cancer.

What Is the Prognosis of Folliculitis Decalvans?

Folliculitis decalvans result in hair loss which makes the person more conscious about their appearance. This condition can result in depression or anxiety. People with scarring can try scalp micropigmentation or hair grafts which can reduce the appearance of the scar. Counseling sessions can help a person towards a self-positive image.

Will There Be Regrowth of Hair?

Unfortunately, the hair does not grow again. The hair loss caused due to folliculitis decalvans is permanent. Proper treatment in the initial stages can help to reduce hair loss.

How Is Folliculitis Decalvans Prevented?

Folliculitis decalvans usually require a long-term treatment method. Using antiseptic shampoo can help to prevent scalp infections caused by bacteria. That shampoo, which contains tar, can help prevent the formation of scarring on the scalp.

Conclusion

Folliculitis decalvans is a condition that results in severe hair fall and scarring caused by infection and inflammation of the hair follicles. This condition has no specific causative factor but is generally caused by Staph A bacteria. There is no cure for this condition. However, early folliculitis decalvans can be diagnosed, and treatment can be done to prevent the condition from worsening. The hair loss caused by folliculitis decalvans is permanent, and the person needs to have a hair graft or micropigmentation done over the baled region.