Can Folliculitis Decalvans Be Cured?

Folliculitis decalvans is a rare form of patchy balding with pustules and scars. There is no cure, but antibiotics and corticosteroids can help manage symptoms.

Folliculitis decalvans is a rare form of adult hair loss (alopecia) that involves scarring. It usually appears as an expanding area of hair loss surrounded by pustules. It’s classified as a form of alopecia called cicatricial alopecia (balding with scars).

Folliculitis decalvans most often affects the scalp but it can affect any hairy region of the body such as the beard, underarm hair, pubic hair, legs, and arms.

Symptoms of folliculitis decalvans include:

• Round or oval patches of hair loss (alopecia)
• Bald patches that are surrounded by pustules (blister-like pimples that contain pus)
• Several hairs may be seen coming out of a single follicle, so the scalp looks "tufted" like a toothbrush
• Balding areas may show
  • Redness
  • Swelling
  • Scarring

The cause of folliculitis decalvans is unknown. Some researchers believe the disease is an abnormal response to bacteria, particularly Staphylococcus aureus. 

There do not seem to be any specific risk factors for developing the condition.

Folliculitis decalvans is usually diagnosed and treated by a dermatologist, a doctor who specializes in diseases of the skin. 

Usually the diagnosis of folliculitis decalvans is made with a physical examination, where a doctor will look at the skin, areas of thinning hair, and pustules. 

Other tests that may be used to help confirm a diagnosis or rule out other conditions include:

• Dermoscopy in which the skin is examined with a high-powered microscope with a light
• Biopsy 

There is no cure for folliculitis decalvans. 

Treatment for folliculitis decalvans is aimed at preventing the condition from worsening. Treatment may include: 

• Oral antibiotics to control pustules and infections from open sores such as minocycline, tetracycline, rifampicin, clindamycin, ciprofloxacin, and/or dicloxacillin
• Topical antibiotics 
• Isotretinoin
• Oral corticosteroids to reduce inflammation 
• Photodynamic therapy

Other therapies that may be useful but require further study to confirm effectiveness include:

• Topical antimicrobial cleansers, such as products containing povidone-iodine or triclosan
• Topical tacrolimus 0.1% ointment
• Fusidic acid, oral or topical
• Dapsone
• Tumor necrosis factor (TNF)-alpha inhibitors such as infliximab and adalimumab
• Intravenous immune globulin (IVIG)  
• Procedural therapies that destroy the hair follicle, including neodymium-doped yttrium aluminum garnet laser and radiation therapy 

Patients may also use cosmetic treatments to cover the hair loss, such as:

• Topical hair fibers
• Powder cakes, lotions, sprays
• Scalp tattooing
• Wigs
• Hairpieces and hair extensions 
• Hair styling techniques to reduce the visibility of the bald areas
• Hair transplantation surgery 

Folliculitis decalvans is limited to the skin and does not affect other organ systems and is not life threatening. Early treatment is the key to limiting hair loss. 

Complications of folliculitis decalvans include:

• Permanent hair loss in the affected areas
• Significant disfigurement due to scarring 
• Recurrent episodes despite treatment