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Folliculitis decalvans

Authors: Vanessa Ngan, Staff Writer, 2003. Updated: Dr Maanasa Bandla, Intern, Monash Health, Melbourne, Australia; Dr Martin Keefe, Dermatologist, Christchurch, New Zealand. Copy edited by Gus Mitchell. August 2021


What is folliculitis decalvans?

Folliculitis decalvans is achronic,neutrophilicinflammationthat results in scarringhairloss. Tufted hair folliculitis is probably a subset of folliculitis decalvans although tufting can be seen in other forms ofcicatricialalopeciaas well.

Folliculitis decalvans

Who gets folliculitis decalvans?

Folliculitis decalvans usually presents in the 4thand 5thdecades, with a male predominance. Children are not affected.

There are probably no racial differences inprevalence, although it has been claimed to be more common in African-American women.

Familialcases have been rarely reported.

What causes folliculitis decalvans?

Folliculitis decalvans is considered to be the result of an abnormal immune response toStaphylococcus aureus, although this is not yet proven.

What are the clinical features of folliculitis decalvans?

Folliculitis decalvans typically affects the scalp, often around the crown, but may affect the beard area,axillae, limbs, and pubic hair. The characteristic clinical features include:

  • Irregular,atrophicwhite patches of scarring and hair loss — solitary or multiple
  • Indurationof the scalp
  • Follicularpustulesandperifollicularcrusts at thepatchperiphery
  • Follicularhyperkeratosis,scale, anderosions
  • Tufting — multiple hair shafts emerge from a single hairfollicle, resulting in a ‘doll’s hair’ appearance
  • Mild itch, discomfort, or pain.

Folliculitis decalvans

Dermoscopyof folliculitis decalvans

  • Tufted hairs
  • White dots
  • Perifollicularerythemaand scale
  • Scattered follicular pustules

What are the complications of folliculitis decalvans?

How is folliculitis decalvans diagnosed?

Folliculitis decalvans is a clinical diagnosis confirmed onbacteriology/mycologyandhistologyif required.

Skinbiopsyof an earlylesionshows a neutrophilicinfiltratedilating theinfundibulumof the hair follicle. The follicle in laterlesionshas ruptured resulting in perifollicular scarring and mixedinflammatoryinfiltrate including foreign bodygiant cells.

What is thedifferential diagnosisfor folliculitis decalvans?

What is the treatment for folliculitis decalvans?

General measures

  • Topicalantiseptics and shampoos — although little evidence forefficacy

Specific measures

What is the outcome for folliculitis decalvans?

Folliculitis decalvans usually follows a chronic fluctuating course ofexacerbationsandremissionsover many years. It is not clear that treatment influences the long-termprognosisdespite successfully reducing inflammation in the short-term. Early diagnosis and treatment are important but permanent hair loss is to be expected.


  • Brooke RC, Griffiths CE. Folliculitis decalvans. Clin Exp Dermatol. 2001;26(1):120–2. doi:10.1046/j.1365-2230.2001.00746.x.Journal
  • Fässler M, Radonjic-Hoesli S, Feldmeyer L, et al. Successful treatment of refractory folliculitis decalvans with apremilast. JAAD Case Rep. 2020;6(10):1079–81. doi:10.1016/j.jdcr.2020.08.019.PubMed Central
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  • Rambhia PH, Conic RRZ, Murad A, Atanaskova-Mesinkovska N, Piliang M, Bergfeld W. Updates in therapeutics for folliculitis decalvans: a systematic review with evidence-based analysis. J Am Acad Dermatol. 2019;80(3):794–801.e1. doi:10.1016/j.jaad.2018.07.050.Journal
  • Senatore S, Maglie R, Maio V, Montefusco F, Antiga E. Folliculitis decalvans with exclusive beard involvement. Indian J Dermatol Venereol Leprol. 2021;87(4):569–71. doi:10.25259/IJDVL_694_20.Journal
  • Tietze JK, Heppt MV, von Preußen A, et al. Oral isotretinoin as the most effective treatment in folliculitis decalvans: a retrospective comparison of different treatment regimens in 28 patients. J Eur Acad Dermatol Venereol. 2015;29(9):1816–21. doi:10.1111/jdv.13052.PubMed
  • Yang A, Hannaford R, Kossard S. Folliculitis decalvans-like pustular plaques on the limbs sparing the scalp. Australas J Dermatol. 2020;61(1):54–6. doi:10.1111/ajd.13178.PubMed

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