Folliculitis decalvans

Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: ED70.50

Quinquaud (1888)

Folliculitis sycosiformis atrophicans (form on the face).

Bacterial-induced chronic inflammatory reaction of the hair follicles leading to fusion of the follicular openings and producing brush hairs ("tufted hair").

Rarely.

No staging. In the vast majority of patients, the disease remains confined to one or a few areas up to 8 x 8 cm in size - but it is highly chronic.

S. aureus is involved and is also regularly found in the nasal vestibule smear.

Scarred alopecic foci (absent follicular openings in the dermoscope) surrounded by pustules and serous crusts (yellowish-glowing in the dermoscope). Tufts and brush hairs due to fusion of follicular openings.

  • Clinical
  • Bacteriology
  • Biopsy often necessary for differentiation from lichen ruber planopilaris.

Scalp, whiskers and eyebrows are less frequently affected. Not found on the rest of the body.

May hurt and itch. Purulent or serous secretion. Severe impairment of quality of life .

Granulocyte-rich inflammation, destroys hair follicles and leads to scarring, irreversible alopecia.

Irreversible hair loss.

Remediation of S. aureus carriage could have a positive role, this has not been investigated so far.

Chronic, hardly any spontaneous improvement tendency.

1          Bunagan MJK, Banka N, Shapiro J. Retrospective Review of Folliculitis Decalvans in 23 Patients with Course and Treatment Analysis of Long-standing Cases. Journal of Cutaneous Medicine and Surgery 2015; 19: 45-9.

2          Karakuzu A, Erdem T, Aktas A et al. A Case of Folliculitis Decalvans Involving the Beard, Face and Nape. The Journal of Dermatology 2001; 28: 329-31.

3          Kaur S, Kanwar AJ. Folliculitis Decalvans: Successful Treatment with a Combination of Rifampicin and Topical Mupirocin. The Journal of Dermatology 2002; 29: 180-1.

4          Powell, Dawber, Gatter. Folliculitis decalvans including tufted folliculitis: clinical, histological and therapeutic findings. British Journal of Dermatology 1999; 140: 328-33.