Decalvante folliculitis or folliculitis decalvans is a form of alopecia (hair loss) involving scarring. It is characterized by redness and swelling and pustules around the hair follicle (folliculitis), leading to destruction of the follicle and consequent permanent hair loss. Decalvante folliculitis is one of the causes of scarring alopecia (baldness with scars) and is sometimes referred to as tufted folliculitis.
Folliculitis decalvans affects both men and women and can start first during adolescence or at any point in adult life. The exact cause is unknown. In most cases, Staphylococcus aureus can be isolated from the pustules, but the role of the bacteria is unclear.
what are the signs and symptoms?
Any hairy region can be involved. It is usually limited to the scalp, but can affect other areas such as the beard, axillary and pubic hair, the lower legs, thighs, and arms. There are usually round or oval patches of hair loss with pustules surrounding the hair follicles (peripheral pustules). Characteristically, several or many hairs can be seen emerging from a single follicle, making the scalp look "tufted" like a toothbrush. Finally the hairs come off when the follicle is completely destroyed and leaves a scar.
There are usually no symptoms, but sometimes the affected area can itch. The disease can be limited to a few small spots or can progress over time causing extensive hair loss.
How is decalvating folliculitis diagnosed?
As other types of hair loss, FD is diagnosed and treated by a trichologist or dermatologist. This type of doctor specializes in diseases of the hair and skin. Depending on your insurance, you may need a referral from your GP if you haven't seen a dermatologist for this condition before. Your GP will perform a physical exam of the spots in question and make this determination.
Once you see a trichologist, they will examine your hair and skin more closely. You will examine the skin and notice any rash or scar. Also, it will look at the pustule areas and thinning hair. All of these symptoms combined could lead to a diagnosis of FD.
Still, it's important for your specialist to rule out other causes of hair loss, such as:
- Hormonal conditions related to pregnancy, menopause, and elevated androgen levels
- A recent acute illness, such as the flu or an infection
- Inactive thyroid (hypothyroidism)
- Radiation exposure
- Cancer Treatments
- Certain medications, such as birth control pills, anabolic steroids, and blood thinners
- Chronic stress
- Stress from a recent traumatic event
- Malnutrition (especially iron and protein deficiencies)
- Vitamin A overdose
- Weight loss
- Eating disorders
- Poor hair care
- Tight hairstyles
Once they are ruled out as causes of hair loss based on your medical history, your specialist may recommend a biopsy. This procedure involves taking a small sample of your scalp or skin. A blood test may also be ordered to help rule out any other underlying problems, such as thyroid disease.
Diagnosing Decalvans Folliculitis can take time. Ultimately, the diagnosis is based on a combination of the following:
- Review of medical history
- Physical exam
- Possible biopsy
- Blood test
What is the treatment of folliculitis decalvans?
There is no permanent cure for the condition but it can be controlled to some degree through the use of medications.
Oral antibiotics such as minocycline, tetracycline, rifampin, clindamycin, fusidic acid, ciprofloxacin, and dicloxacillin have been tested with varying results from patient to patient.
In some serious forms, it may be necessary to add an oral corticosteroid.
Oral isotretinoin can cause long-term remissions in some patients.
Photodynamic therapy with methyl aminolevulinate has been reported to lead to clinical improvement.
What is the prognosis for decalvating folliculitis?
People with FD are at risk of scarring and permanent hair loss in affected areas of the body. Sometimes this is condensed into patches of skin. In more severe cases, baldness and general scarring can occur.
Since there is no cure for FD, it is important to seek early treatment to prevent the condition from progressing.