Folliculitis Decalvans | Know its Causes, Symptoms, Diagnosis and More

What is Folliculitis Decalvans?

Folliculitis Decalvans (FD) is a rare, chronic, cicatricial (scarring) scalp condition. It classically occurs as an expanding patch of alopecia or patchy hair fall. The term 'folliculitis' is a Latin word meaning inflammation of the hair follicles.

FD accounts for almost 11% of primary cicatricial alopecia cases. It occurs mainly in young and middle-aged adults, with a slight prevalence among the male gender.

Folliculitis Decalvans Symptoms

Apart from the scalp, FD can also show symptoms in the arms, chest, face, beard, legs, and pubic region. Some noticeable symptoms are:

Pustules surrounding the hair follicles.
Tufted scalp - many strands of hair growing from a single follicle.
Redness, swelling, scarring, and itchiness in the balding areas.

The condition may progress over time, causing extensive hair loss. However, some individuals may not experience symptoms at all.

Also read: 4 regions of the scalp or sections of the head

Causes of Folliculitis Decalvans

Folliculitis Decalvans is a cross between folliculitis and alopecia. There can be various causes for both these conditions. The exact cause of FD is unknown.
Some say that it is an abnormal response to Staphylococcus aureus bacteria. It is a germ most commonly found on the skin or in the nose of healthy individuals too. However, the extent of the bacteria’s involvement in causing FD is undetermined.
It is not a contagious disease but occurs due to an altered immune response. It is not usually hereditary. However, some reports insinuate its effects on members of the same family.
It can happen to anyone, even members who maintain good health overall. There are no specific risk factors.

Diagnosis of Folliculitis Decalvans

Like most hair, skin conditions, the diagnosis of FD is carried out by a dermatologist.

Folliculitis Decalvans Dermoscopy may be done in the following ways:

Medical history check and a questionnaire: The doctor needs to be sure of your medical background before prescribing anything severe.
Use of a handheld magnifying device to look closely at hair follicles.
A skin swab may be taken and sent to laboratories to check for germs.
Skin biopsy - cutting and removing a small skin sample for further examination.

Before beginning FD treatment, the specialists check for other regular causes of hair loss like:

Patches of hair loss that may develop after radiation exposure.
Stress: Stress can push hair follicles into a resting phase, disabling them to produce new hair. The condition is called telogen effluvium.
Flu: Some conditions like fever, sore throat, and sinus infection also lead the hair into telogen effluvium.
Eating disorders: An imbalanced meal causes a lack of nutrients in your body essential for healthy hair growth.
Vitamin A, Vitamin E, or Selenium overdose.
Poor hair care: Men often ignore hair care, causing hair strands to become dry and brittle. Using the right hair oil is a step in the right direction.

Sometimes, the dermatologist may ask for a blood test to rule out any other underlying issues like thyroid.

Treatment of Folliculitis Decalvans: Can Folliculitis Decalvans be Cured?

There is no sure-shot cure for FD. Several treatments are available to control inflammation. However, no cure has been found which can completely eradicate this condition. Once scarring begins, it is permanent. With proper treatment, you may notice fewer symptoms, pustules, and a reduction in hair loss.

Treatments for FD may include:

Antimicrobials

Antibiotics such as Minocycline, Rifampicin, and Clarithromycin prevent the destruction of hair follicles. The duration and frequency of medication depend upon the severity of the condition.

Clindamycin Solution

One can apply this Clindamycin solution or gel topically two times a day for 5 to 7 days. It is effective against S. aureus.

Self Care

Using a folliculitis shampoo is helpful. One can use mild shampoos as often as desired. Antidandruff shampoos with antifungal agents like ketoconazole or ciclopirox are also beneficial. You can apply a conditioner if you wish.

Fusidic Acid

A silver lining: A 2019 study also shows successful treatment of FD with Fusidic Acid in a 41-year woman. Another report claims to cure the condition using manuka honey, denser than regular honey and has antibacterial properties.

Also read: Dandruff vs. a dry scalp. Knowing the difference

Conclusion

Inflammation can stop and burn itself out, but one can experience flares on and off for months, maybe years. Folliculitis Decalvans is a condition that requires ongoing long-term treatment. One must regularly visit the dermatologist keeping the situation under control.