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What Is Folliculitis Decalvans?

Medically Reviewed by Jabeen Begum, MD on October 19, 2021

Folliculitis decalvans is a rare form of alopecia or hair loss. It usually begins in adulthood. The primary symptoms are patchy hair loss with inflammation, and pimple-like sores around the area where hair falls out.

Experts are not sure what causes this condition. There is no cure for folliculitis decalvans. Doctors can help you treat your symptoms and reduce the long-term effects like scarring. 

What Are the Symptoms of Folliculitis Decalvans?

Folliculitis decalvans usually affects the skin on your scalp, most often on the back of the head. You will notice irritated spots with sores or pimple-like bumps on them. You may have discomfort in the affected areas. The affected hair will fall out, leaving round or oval-shaped bald patches.

The scalp is the most common site of folliculitis decalvans. Some people are affected in other areas with heavy hair, such as the armpits, pubic area, or on the skin under a beard.

Major symptoms of folliculitis decalvans include: 

  • Patches of hair loss
  • Clusters of pustules around bald patches
  • Several hairs growing out of a single follicle, causing a tufted appearance like the bristles on a toothbrush
  • Redness or swelling of the scalp

You may have scaly or crusted patches of skin in the affected areas of your scalp. Some people say the affected spots feel tight or sore. Itching is another common symptom. The condition can cause scarring on your scalp. The scars lead to permanent hair loss because new hair doesn’t grow through the scar tissue.  

What Causes Folliculitis Decalvans?

There hasn’t been much research into the causes of folliculitis decalvans. But some experts suspect it’s caused by an unusual reaction to the bacteria staphylococcus aureus, which is commonly found on the skin. Most people tolerate the bacteria without a problem. People with folliculitis decalvans seem to have a strong immune response to it that leads to skin irritation and hair loss.  

The condition isn’t contagious, so there is no risk of passing it to other people. Doctors can diagnose it by doing an examination of your scalp and ruling out other conditions such as psoriasis or acne. They may take a small biopsy or skin scraping to look for staphylococcus aureus. 

Who Can Get Folliculitis Decalvans?

Folliculitis decalvans is a very rare condition that mainly shows up in adults. It’s more common in men than women.

Experts haven’t found any common risk factors for folliculitis decalvans. There are some reports of people in the same family having the condition, so there may be a genetic factor. Race, age, and health history don’t seem to affect the likelihood of developing folliculitis decalvans. 

What is the Treatment for Folliculitis Decalvans?

There is no cure for folliculitis decalvans, but some treatments can relieve symptoms of folliculitis decalvans. They may include:

  • Oral antibiotics to clear up any sores or pustules that are on your scalp
  • Topical antibiotics that can reduce the presence of staphylococcus aureus
  • Isotretinoin to treat pustules
  • Oral or topical corticosteroids to reduce inflammation, pain, and itching
  • Photodynamic therapy to reduce the severity of symptoms 

There have been limited reports that medicine used for treating psoriasis may help some people with folliculitis decalvans.

Your doctor may suggest that you use medicated shampoos to prevent the growth of bacteria on your scalp. Shampoos with ingredients such as coal tar may help with itching or flaking from folliculitis decalvans. Over-the-counter anti-itch creams or ointments may also provide relief from symptoms.

Some people find that folliculitis decalvans goes away over time. Other people have recurrences off and on for many years. Your doctor can help you manage flare-ups when they occur.

One of the side effects of folliculitis decalvans is hair loss. The damage to your scalp can lead to permanent bald patches. This can affect your appearance and impact your self-esteem. 

There are a number of options for concealing hair loss. Artificial hair, such as extensions or wigs, can help improve the look of your hair. Hair transplantation surgery may be an option for some people.

Cosmetics can cover some patches of missing hair. You can use accessories like hair bands or clips to style hair and disguise hair loss so others won’t see any bald spots. Hats and scarves can be stylish ways to cover hair loss, as well.‌

Early diagnosis and treatment of folliculitis decalvans can minimize hair loss. If you suspect you have folliculitis decalvans, talk to your doctor. They can help find a treatment plan that will reduce your risk of losing hair. 

You can discuss these options with your doctor or see a hairstylist for suggestions. 

Show Sources

‌SOURCES: 

Australasian College of Dermatologists: “Folliculitis Decalvans.”

British Association of Dermatologists: “FOLLICULITIS DECALVANS.”

JAAD Case Reports: “Successful treatment of refractory folliculitis decalvans with apremilast.”

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