What is Folliculitis decalvans?
Folliculitis decalvans is a progressive disorder of the scalp that is characterized by inflammation and scarring. It causes inflammation of the hair follicles which makes the follicles accompanied by redness and swelling.
This ultimately destroys the follicles and results in permanent hair loss. The chronic inflammation further leads to scarring and folliculitis decalvans progresses to cicatricial alopecia (baldness with scarring).
This condition affects both men and women and can occur at any time from adolescent to adult life. However it has been observed that men are more likely to have an early onset from adolescence whereas women tend to develop it much later in their life after 40 years of age.
What causes Folliculitis decalvans?
Still the exact cause of folliculitis decalvans is not known. But the organism staphylococcus aureus seems to play a role in the pathogenesis of the disease as it is found in the pustular lesions.
Staphylococcus aureus constitutes the normal flora of the skin. It is debatable if the bacteria are simply colonizing the infection or it is primarily responsible for inducing an immune response.
Another causative possibility suspected is a strong abnormal inflammatory response to the pathogen. Also, familial investigations have led to the conclusion that there is a certain genetic predisposition linked to this disorder.
What are the signs and symptoms of folliculitis decalvans?
The main feature of folliculitis decalvans is follicular scarring and pustules, which may be purulent. Patients also report itching, pain and a burning sensation.
In many cases, crusting around the pustules and spontaneous bleeding is also observed. Folliculitis decalvans predominantly starts at the occipital and vertex region and is restricted to a few patches or advances to cicatricial alopecia with many oval patches of scars.
Tufted folliculitis is a common feature of folliculitis decalvans. When various hairs sprout out of a single follicle, it is called tufting.
These tufts of hair are shed and the follicles are eventually destroyed thus leaving a scar. However, many people do not encounter and specific symptoms at all.
What is the treatment of folliculitis decalvans?
The primary cause of folliculitis decalvans is unknown. This makes it difficult to find the right treatment.
However, the bacteria staphylococcus aureus along with poor immunity and an inflammatory response leads to the development of this condition.
The treatment primarily aims at eliminating staphylococcus aureus. There is no specific cure available to treat folliculitis decalvans but the disease can be restrained to smaller patches by antibiotic therapy.
It includes topical antiseptics, topical and oral antibiotics, for example rifampicin along with clindamycin has shown to be effective.
Topical antibiotics accompanied by intranasal therapy have shown positive results. Corticosteroids provide symptomatic relief and subside inflammation. Oral therapy including dapsone and zinc sulphate has also shown positive effects to an extent.