Folliculitis decalvans

Last Updated: 2019-08-27

Author(s): -

Quinquaud (1888)

Folliculitis sycosiformis atrophicans (form on the face).

Bacterially caused chronic inflammatory reaction of the hair follicles, which leads to a fusion of the follicle openings and produces tufted hair.

Rarely.

No stadium classification. In the vast majority of patients, the disease remains restricted to one or a few areas measuring up to 8 x 8 cm - but it is highly chronic.

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

Scarred alopecic herd (missing follicle openings in the dermatoscope), surrounded by pustules and serum crusts (yellowish glowing in the dermatoscope). Tufts and brush hairs by fusion of the follicle openings. Attention: 2-3 hairs per follicle opening can also be found in healthy individuals.

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

Scalp, beard hair 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 the hair follicles and leads to scarring, irreversible alopecia.

Irreversible hair loss.

Remediation of S. aureu's sponsorship could have a positive effect; this has not yet been properly investigated.

Chronic, hardly any spontaneous improvement.

  • Antiseptics
  • Fucidic acid topical
  • Isotretinoin
  • Clindamycin
  • Flucloxacillin
  • Clindamycin und Rifampicin

Personal remarks of the authors:

  • Off-label use of apremilast (2 patients) and secukinumab (2 patients) showed no success.

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.