Folliculitis Decalvans: Symptoms, Causes, and Treatments
Folliculitis decalvans (FD) is a rare but significant form of scarring alopecia caused by chronic inflammation of the hair follicles. It is the most common type of primary neutrophilic cicatricial alopecia, diagnosed in about 2.8% of patients with hair disorders.
This condition can lead to permanent hair loss, especially on the scalp, and is often associated with considerable aesthetic and psychological discomfort.
Causes and Mechanism of Folliculitis Decalvans
The exact pathogenesis of folliculitis decalvans is not yet fully understood. However, several factors are believed to contribute to its development, including:
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Genetic predisposition
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Colonization by Staphylococcus aureus
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Formation of bacterial biofilms
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Alterations of the skin barrier
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Local trauma or micro-injuries
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Congenital abnormalities of the follicular openings
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Dysfunction of the local immune system
These factors can trigger chronic inflammation of the hair follicle, leading to its gradual destruction, scarring, and irreversible hair loss.
Who Is Affected by Folliculitis Decalvans
Folliculitis decalvans primarily affects young to middle-aged adults, with a higher prevalence in men.
Main Symptoms
Clinically, folliculitis decalvans is characterized by:
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Follicular papules and pustules (small inflamed or pus-filled lesions)
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Hair tufts emerging from a single follicle
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Purulent or hemorrhagic crusts
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Scarring areas with complete hair loss
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Itching, pain, or burning sensations (trichodynia)
The vertex of the scalp is most commonly affected, but other areas such as the beard, neck, armpits, and pubic regionmay also be involved.
Diagnosis and Treatment
Diagnosis is based on dermatological examination, often supported by trichoscopy and skin biopsy.
Treatment focuses on reducing inflammation and controlling bacterial growth to prevent new lesions and minimize hair loss. Therapeutic options may include:
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Topical or systemic antibiotics (e.g., rifampicin and clindamycin)
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Topical or intralesional corticosteroids
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Anti-inflammatory or immunomodulatory agents (such as doxycycline or isotretinoin)
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Supportive therapies to promote hair regrowth and scalp health
Prognosis
Folliculitis decalvans is a chronic condition that typically progresses slowly.
Early and personalized treatment can help limit disease progression and preserve as much hair density as possible.
Trichology consultation with digital trichoscopy in Verona
At our medical clinic, you can book a trichology consultation in Verona with Dr. Fabrizio Presta. During the consultation, an innovative examination is performed: digital trichoscopy with videodermatoscope.
Thanks to the latest-generation technology, Fotofinder Universe 3, this device allows us to:
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Precisely assess the condition of the hair follicles
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Record detailed images of the scalp
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Monitor the progression of hair loss over time
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Produce the RFT (Trichological Photographic Report): a photographic documentation delivered to the patient, useful for tracking progress during therapy
Learn more about the main hair diseases
Find out more about the different types of alopecia and available treatments:
