Folliculitis Decalvans

Folliculitis decalvans is a condition in the scarring (cicatricial/permanent) alopecia group that arises from a type of inflammatory reaction affecting the hair follicles and can lead to permanent hair loss over time. With early diagnosis and appropriate treatment, it is possible to bring the condition under control and prevent the hair loss from progressing.

The condition most often affects the crown and back of the scalp. Spot-like bumps, inflammation, crusting, pain, tenderness, itching, foul-smelling discharge and occasional bleeding can be seen on the scalp. Hair loss develops over time in the affected areas. In some patients, several hairs emerging in a cluster from the same follicle (tufted hair) is a fairly characteristic finding.

Symptoms may ease and flare again from time to time. For this reason, the correct diagnosis can be delayed in patients whose condition has long been considered “dandruff”, “eczema” or “persistent scalp spots”. Delay in treatment, in turn, can allow permanent hair loss to progress.

Detailed clinical assessment and trichoscopic examination are very important in diagnosis. Trichoscopy allows the activity of the condition to be assessed and the differential diagnosis from other scalp conditions to be made. Where deemed necessary, a scalp biopsy and microbiological investigations may be used to support the diagnosis.

The aim of treatment is to bring the inflammation in the follicles under control, prevent new lesions and preserve the existing hair. To this end, topical and oral medications may be planned together according to the severity of the condition.

Folliculitis decalvans is a chronic condition. Even when it is brought under control, flares can occur from time to time, so regular follow-up is important.