Folliculitis Decalvans

Folliculitis Decalvans, a chronic dermatological condition, epitomizes a complex interplay between neutrophilic inflammation and an aberrant immune response, predominantly to Staphylococcus aureus, resulting in scarring alopecia. With its onset usually in adulthood, the disease manifests through a constellation of symptoms, including pustules, crusts, and irreversible hair loss, largely affecting the scalp. Despite its prevalence and impact on quality of life, the pathophysiology remains only partially understood, and treatment options, while varied, do not offer a cure but aim to attenuate symptoms and halt progression. This gap in understanding beckons a deeper exploration into its mechanisms, promising avenues for therapeutic intervention, and the psychological impact on affected individuals.

What is Folliculitis Decalvans?

Q: What exactly is Folliculitis Decalvans?
A: Folliculitis Decalvans is a rare and chronic condition that leads to inflammation and scarring on the scalp. This inflammation damages hair follicles, causing hair to fall out and leave behind scars, resulting in permanent hair loss in the affected areas. It is also known as cicatricial alopecia.

Who Gets Folliculitis Decalvans?

Q: Who is most likely to develop Folliculitis Decalvans?
A: Folliculitis Decalvans usually shows up in adults, with a higher occurrence noted among men. It typically starts during the teenage years or early adulthood but is seen more frequently in the 4th and 5th decades of life. It's important to note that this condition generally does not affect children.

What Causes Folliculitis Decalvans?

Q: What causes Folliculitis Decalvans?
A: The exact cause remains a bit of a mystery, but it's thought to involve an abnormal immune system reaction to Staphylococcus aureus, a type of bacteria. This abnormal response leads to ongoing inflammation and eventual destruction of the hair follicles.

How Do I Know If I Have Folliculitis Decalvans?

Q: What are the symptoms of Folliculitis Decalvans?
A: Symptoms include itchy and painful spots on the scalp, tightness or pain in the scalp, bald spots that may have bumps or scabs, and, in some cases, yellowish discharge. The condition often leads to scarring and permanent hair loss in the affected areas.

How is Folliculitis Decalvans Diagnosed?

Q: How do doctors diagnose Folliculitis Decalvans?
A: Diagnosis involves a thorough examination by a dermatologist, who may use a magnifying device to get a closer look at the scalp. Tests can include swabs of pustule fluid, plucking hair for examination, or performing a skin biopsy to confirm the diagnosis.

Can Folliculitis Decalvans Be Treated?

Q: What are the treatment options for Folliculitis Decalvans?
A: While there's no cure, treatments aim to reduce inflammation and prevent further hair loss and scarring. Options include medicated shampoos, scalp solutions, antibiotics, corticosteroids, and, in some cases, photodynamic therapy. Wigs and hair sprays can be used for cosmetic improvement, and hair transplants might be an option after achieving long-term remission.

How Common Is Folliculitis Decalvans?

Q: Is Folliculitis Decalvans a common condition?
A: No, it's quite rare. It affects both men and women but is more common in men. There are no significant differences in prevalence among different racial groups, though it's somewhat more common in African-American women.

Can Folliculitis Decalvans Be Prevented?

Q: Can I do anything to prevent Folliculitis Decalvans?
A: Since the exact cause is unknown, specific prevention strategies are challenging to recommend. However, maintaining good scalp hygiene and regular dermatological check-ups might help early detection and management, potentially preventing severe scarring and hair loss.

What Complications Can Arise From Folliculitis Decalvans?

Q: Are there any complications associated with Folliculitis Decalvans?
A: The main complication is permanent hair loss due to scarring. Additionally, the condition can have a significant psychological impact due to the visible hair loss. There's also a risk of developing squamous cell carcinoma in the affected areas, though this is rare.

Medically reviewed and fact checked by 
Dr. Dorina Soltesz, MD

Dr. Dorina Soltesz ABHRS
Hair restoration expert, American Board of Hair Restoration Surgery (ABHRS) certified hair transplant surgeon.

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