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What Is Folliculitis Decalvans?

Folliculitis decalvans, also known as Quinquaud's decalvans folliculitis or tufted hair folliculitis, is a rare form of scarring baldness or alopecia that affects the scalp. It is most often seen in men and results in baldness and scarring in the affected areas. It is not known to be a fatal disease, but can cause both physical and mental distress due to the discomfort and disfigurement it causes.

  1. Causes

    • It is not known exactly what causes folliculitis decalvans, but cultures of the lesions often show that the areas are infected with staphylococcal organisms. It is believed that new follicular epithelium forms around hair shafts, causing inflammation and scarring in the upper dermal tissue, which causes several hair follicles to emerge from a single follicular opening. It is believed that the staphylococcal infection is not the cause, but actually invades the areas due to the inflammation already present in the areas.

    Clinical History

    • Folliculitis decalvans is seen only in adults, the usual age of onset is 40 to 50 years old. These individuals usually report a hair loss that develops slowly over the years. They frequently report pain, swelling, and crust and scale development of the scalp. It usually starts as a single area of the scalp and gradually enlarges. Patients with folliculitis decalvans are often plagued with acne keloidalis, a severe form of scar-forming acne.

    Symptoms

    • Examination of the hair follicles reveals that several hair follicles are emerging from a single follicular opening, hence giving the hair a "tufted" appearance. This is often referred to as a "doll's hair pattern." The area of involvement is usually well-defined. There may be noticeable redness, swelling and tenderness to the area. Scaling and crusting may be present and is usually noted along the outer margins of the affected area(s).

    Treatment

    • Treatment for folliculitis decalvans includes the use of antibiotics to treat and control the accompanying infections. The areas should be cultured to make sure the appropriate antibiotic is used. Often, corticosteroids, either as an oral medication or most often as a topical treatment, are ordered. These corticosteroids are used to control the redness, swelling and inflammation of the affected areas. While there is no known cure for folliculitis decalvans, treatment is aimed at stopping further damage and preventing recurrence of the disease.

    Insight From Experts

    • The frequency of folliculitis decalvans is rare, both in the United States and internationally. There seems to be no predilection for any certain race. It is most commonly seen in men, although there are cases reported in women. It usually attacks in the late 40s or early 50s. It is not known to cause death, although the accompanying infections may lead to morbidity.

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