Folliculitis Decalvans

Overview

What is folliculitis decalvans?

Folliculitis decalvans is a rare condition that causes ongoing (chronic) inflammation of your hair follicles and scalp. Over time, hair falls out and scarring occurs. The condition causes permanent hair loss with scarring (cicatricial alopecia).

What is folliculitis?

Folliculitis is inflammation of the hair follicle. Follicles are the bulb-shaped root that anchors hair to your scalp and generates new hair. Bacteria trapped in the inflamed hair follicle can cause small pus-filled bumps called pustules to form. These red, oozing pustules look like acne.

Symptoms and Causes

What causes folliculitis decalvans?

Experts aren’t sure what causes folliculitis decalvans. A staphylococcus infection (staph infection) may be to blame. Some people seem to have an unusual reaction to Staphylococcus aureus (Staph A). This bacterium is naturally found on your skin and inside your nose.

Staph A is usually harmless. But for some people, the bacteria causes ongoing inflammation. Over time, this inflammation destroys hair follicles, preventing them from growing new hair. Eventually, hair falls out, leaving scars. This hair loss (also known as alopecia) is permanent.

What are the risk factors for folliculitis decalvans?

Folliculitis decalvans can cause permanent hair loss in women and men. It more often affects men and people assigned male at birth. It often starts during the teen years or early adulthood but can develop at any time.

What are folliculitis decalvans symptoms?

Folliculitis decalvans typically affects only your scalp, causing round or oval-shaped bald spots. Rarely, hair loss occurs in other regions. It can affect your armpits, genitals, face, legs and arms.

Some people don’t have noticeable symptoms until they begin to lose hair. Others may have an itchy scalp that feels like dandruff (seborrheic dermatitis).

The scalp may feel tight or painful. Pustules most commonly appear on the back of your head but can occur anywhere on your scalp. You may feel scaly skin or crusts after the pustules ooze and form scabs.

Folliculitis decalvans causes hair to grow in tufts. Several strands of hair grow from the same follicle, like bristles on a toothbrush. For this reason, the condition is also called tufted folliculitis. When the follicle dies, the tufts of hair fall out, leaving a scar and bald spot.

Diagnosis and Tests

How is folliculitis decalvans diagnosed?

A dermatologist, a medical doctor who specializes in the diagnosis and treatment of skin conditions, will examine your scalp. Your provider may use a magnifying device to view the pustules more clearly.

Your provider may also:

  • Take a swab of the pustule fluid to check for the presence of Staph A.
  • Pluck a few strands of hair and take skin scrapings from the scalp to test for ringworm. This fungal infection causes similar symptoms.
  • Perform a skin biopsy to confirm the diagnosis.

Management and Treatment

Can folliculitis decalvans be cured?

There isn’t a cure for folliculitis decalvans. But treatments can reduce inflammation and prevent scarring and further hair loss. The condition sometimes goes into remission (no symptoms) but can return and cause a flare (active symptoms). Treatment is often an ongoing process.

Folliculitis decalvans treatments include oral:

  • Antibiotics to kill Staph A bacteria. Staph bacteria can develop antibiotic resistance, which makes the drugs ineffective. MRSA is a type of staph bacterium that doesn’t respond to most antibiotics, including methicillin.
  • Corticosteroids to ease inflammation.
  • Isotretinoin (Accutane®) to clear up the pustules.

Some studies suggest that methyl aminolevulinate photodynamic therapy (MAL-PDT) helps. This treatment uses a chemical applied to the scalp. The chemical reacts to a special light to kill bacteria and cells.

How can you manage folliculitis decalvans?

Your provider may recommend an antiseptic shampoo or a shampoo containing tar to kill bacteria on your scalp.

Outlook / Prognosis

What is the outlook for people with folliculitis decalvans?

Hair loss from folliculitis decalvans may make you self-conscious about your appearance. This may lead to depression or anxiety. Hair loss treatments like hair grafting or scalp micropigmentation may make the bald spots less noticeable. You can also wear a wig, hairpiece or head covering. A counselor can help you take steps to foster a positive self-image.

Living With

What should I ask my provider?

You may want to ask your healthcare provider:

  • What caused folliculitis decalvans?
  • What are my treatment options?
  • How long will I need treatment?
  • Are there steps I can take to prevent additional hair loss?

Frequently Asked Questions

Is folliculitis decalvans contagious?

No, you can’t catch folliculitis decalvans from someone else. The condition sometimes affects members of the same family, but experts aren’t sure why.

Is folliculitis decalvans a type of skin cancer?

No, folliculitis decalvans isn’t skin cancer. Having the condition doesn’t increase your cancer risk.

Will hair grow back after having folliculitis decalvans?

Unfortunately, hair loss from folliculitis decalvans is permanent. If you notice symptoms, seeking treatment right away may help you minimize hair loss.

A note from Cleveland Clinic

Folliculitis decalvans causes bald patches and red, crusty pustules to form on the scalp. Experts aren’t sure why some people develop this condition, although Staph A bacteria may play a role. Antibiotics, steroids and other treatments can help ease inflammation and prevent more hair loss. The hair loss is permanent, but certain hair loss treatments may help. Talk to your provider if you become self-conscious about your appearance.

Last reviewed by a Cleveland Clinic medical professional on 04/14/2022.

References

  • American Academy of Dermatology Association. Folliculitis. (https://www.aad.org/public/diseases/a-z/folliculitis) Accessed 4/14/2022.
  • British Association of Dermatologists. Folliculitis Decalvans. (https://www.bad.org.uk/shared/get-file.ashx?id=165&itemtype=document) Accessed 4/14/2022.
  • DermNet NZ. Folliculitis Decalvans. (https://dermnetnz.org/topics/folliculitis-decalvans/) Accessed 4/14/2022.
  • Merck Manual (Consumer Version). Alopecia (Hair Loss). (https://www.merckmanuals.com/home/skin-disorders/hair-disorders/alopecia-hair-loss) Accessed 4/14/2022.
  • Merck Manual (Consumer Version). Folliculitis and Skin Abscesses. (https://www.merckmanuals.com/home/skin-disorders/bacterial-skin-infections/folliculitis-and-skin-abscesses) Accessed 4/14/2022.
  • Rambhia PH, Conic RZ, Murad A, et al. Updates in therapeutics for folliculitis decalvans: A systematic review with evidence-based analysis. (https://www.jaad.org/article/S0190-9622(18%2932354-5/fulltext) Journal of the American Academy of Dermatology. 2019;80(3):794-801. Accessed 4/14/2022.

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