Folliculitis decalvans: Description, Causes and Risk Factors:
Alternative Names: Quinquaud's decalvans, acne decalvans.
There are two major scalp diseases dominated by neutrophilic inflammation:
Dissecting cellulitis of the scalp, also known as perifolliculitis capitis abscedens et suffodiens.
Both are neutrophilic scalp diseases with recurrent, painful, and suppurative follicular inflammation causing scarring hair loss that is often compared to deforestation by forest fire.
Folliculitis decalvans is a form of alopecia (hair loss) that involves scarring. It is characterized 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.
It is not known exactly what causes folliculitis decalvans, but cultures of the lesions often show that the areas are infected with staphylococcal organisms. It is believed that new follicular epithelium forms around hair shafts, causing inflammation and scarring in the upper dermal tissue, which causes several hair follicles to emerge from a single follicular opening. It is believed that the staphylococcal infection is not the cause, but actually invades the areas due to the inflammation already present in the areas.
Folliculitis decalvans predominantly occurs in young and middle-aged adults with a slight preference of the male gender. Folliculitis decalvans seems to occur more frequently in African Americans compared to Caucasians.
The disorder begins with pimple eruptions, which encompass hair follicles. Neutrophilic inflammation eventually follows, brought about by bacterial invasion. The affected area typically reddens, may swell, and is often itchy or uncomfortable. The pustules usually rupture, exude fluid, then form crusts. The condition eventually destroys the hair inside of the follicle, leaving a scar and inhibiting future hair growth. The affected area of the scalp frequently resembles the bristles on a hairbrush, as bald patches intermingle with follicles containing multiple hairs. Under these circumstances, the condition might be referred to as tufted folliculitis. At other times, folliculitis decalvans produces larger, more noticeable, rounded or ovoid bald spots. The condition can be self-limiting to one small location or spread extensively to surrounding areas.
The differential diagnosis include dissecting folliculitis, acne keloidalis nuchae, pustular dermatosis, of scalp, lichen planopilaris and tufted folliculitis, which is considered a variant of folliculitis decalvans.
Diagnosis of the condition is based on clinical, microbiological, histopathological, and laboratoryfeatures.A detailed clinical history is the ?rst step in thediagnosis of FD. Beside a general medical history,the patient should be asked about the time of onset. The next step is a thorough examination of the entire scalp. Diagnostic tools, such as a 3-foldmagnifying lens, a 10-fold magnifying dermatoscope, or a 60- to 200-fold magnifying Folliscope with and without polarizedlight, can help to identify the presence or absenceof follicular ostia, perifollicular erythema, and follicular hyperkeratosis in the affected areas.
Folliculitis decalvans is a difficult condition to treat but it can be controlled with topical treatments and tablets. The evidence for any of the treatments in this condition is poor.
: Anti-septic washes, combined with topical anti-bacterial treatments can be beneficial. Oral antibiotics are required in addition to this in most patients. Commonly used drugs include tetracycline based antibiotics (as used in acne) and combinations of antibiotics such as rifampicin and clindamycin.
Topical Steroids: In addition to antimicrobials, topical steroids in the form of lotions, gels or mousses can help control the condition.
Topical calcineurin inhibitors
: Although not licensed for this indication, these topical treatments can be useful in the management of folliculitis decalvans and do not have the potential to skin thinning seen with topical steroids.
Isotretinoin: This derivative of vitamin A is used commonly for severe acne. It can be useful in this condition but requires consultant supervision.
Risks and benefits of medications must be carefully discussed with your PCP before taking any medications.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
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DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.