What Is Folliculitis Decalvans?

• Folliculitis Decalvans Treatments

Folliculitis decalvans (FD) is a rare inflammatory disorder that causes cicatricial hair loss. Unlike many other types of cicatricial alopecia, FD occurs mostly in men.^(76, 184)

Symptoms of Folliculitis Decalvans

Specific symptoms of FD include:

• Crops of pustules around the hair follicle⁽¹⁸⁵⁾
• Painful scalp lesions⁽¹⁸⁴⁾
• Soft and boggy scalp in some patients⁽¹⁸⁵⁾

Bacteria are frequently found in FD pustules and require antibiotic treatment. In addition to infected pustules, there appears to be an imbalance in the scalp's natural microbiome.^(185, 460)

Researchers have found that harmful bacteria are not only present in the lesions but on clear areas of the scalp. Some patients with FD require years of antibiotics, gradually tapering off before stopping treatment.^{(185, 460, 461)}

Treatments for Folliculitis Decalvans

There is no standard treatment for folliculitis decalvans. However, a variety of treatments are effective in improving the condition over time.⁽⁴⁶¹⁾

These include:

• Antibiotics (especially the combination of rifampicin and clindamycin)⁽¹⁸⁵⁾
• Antifungal drugs⁽¹⁸⁴⁾
• Antimicrobial medication⁽¹⁸⁴⁾
• Fusidic acid⁽¹⁸⁵⁾
• Isotretinoin⁽⁴⁶²⁾
• Laser depilation⁽¹⁸⁴⁾
• Topical steroids⁽¹⁸⁵⁾
• Zinc sulfate⁽¹⁸⁵⁾

Rates of Treatment Success for FD

Clinical research suggests combination therapy can be helpful in preventing permanent hair loss. Results of a 12-month clinical study using the following healed lesions and regrew hair in thirteen patients with mild to moderate FD:⁽¹⁸⁴⁾

• Systemic antibiotics
• Oral glycyrrhizin and zinc supplements
• Topical fusidic acid or mupirocin
• Selenium sulfide shampoo

Those patients who didn't initially respond were also given 250 mg twice daily of clarithromycin or 10 mg/day of acitretin.⁽¹⁸⁴⁾

Results of a Cochrane analysis of multiple clinical studies between 1998-2018 demonstrate the difficulty in achieving long-term remission for FD. According to the review, 10 weeks of treatment with clindamycin and rifampicin provides the longest remission from FD (a little over 7 months).⁽⁴⁶⁴⁾

However, in a recent clinical review, oral isotretinoin provided up to 2 years of stable remission for 90% of users. In patients with FD that is resistant to other treatments, phototherapy may help.^(462, 463)