Folliculitis decalvans is a form of alopecia (hair loss) that involves scarring. It is characterised by redness and swelling and pustules around the hair follicle (folliculitis) that leads to destruction of the follicle and consequent permanent hair loss. Folliculitis decalvans is one cause of cicatricial alopecia (baldness with scarring) and is sometimes known as tufted folliculitis.
Folliculitis decalvans affects both men and women and may start first during adolescence or at any time 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 not clear.
What are the signs and symptoms?
Any hairy region may be involved. It is usually confined to the scalp but can involve other sites including the beard, underarm and pubic hair, lower legs, thighs and arms. There are usually round or oval patches of hair loss in which there are pustules surrounding the hair follicles (perifollicular pustules). Characteristically, several or many hairs can be seen coming out of a single follicle, so the scalp looks "tufted" like a toothbrush. Eventually the hairs are shed as the follicle is completely destroyed and leaves behind a scar.
Usually there are no symptoms but sometimes the affected area may be itchy. The disease may remain limited to a few small patches or may progress over time causing extensive hair loss.
What is the treatment of folliculitis decalvans?
There is no permanent cure for the condition but it can be controlled to some degree by using medications.
- Oral antibiotics such as minocycline, tetracycline, rifampicin, clindamycin, fusidic acid, ciprofloxacin and dicloxacillin have all been tried with varying results from patient to patient.
- In some severe forms, addition of an oral corticosteroid may be necessary.
- Oral isotretinoin can result in long-term remissions in some patients.
- Methyl aminolevulinate photodynamic therapy is reported to result in clinical improvement
Book: Textbook of Dermatology. Ed Rook A, Wilkinson DS, Ebling FJB, Champion RH, Burton JL. Fourth edition. Blackwell Scientific Publications.
On DermNet NZ:
- Tufted hair folliculitis – Medscape Reference
- Folliculitis decalvans – British Association of Dermatologists
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