Folliculitis Decalvans

Folliculitis decalvans (FD) is a chronic, scarring type of hair follicle inflammation that primarily affects the scalp. It is a relatively uncommon condition that affects individuals of all ages, but it is most commonly diagnosed in men between the ages of 20 and 40. FD is characterized by the development of small, pus-filled bumps on the scalp that eventually lead to scarring, hair loss, and permanent bald patches.

Causes

The exact cause of FD is not well understood, but several factors are believed to contribute to its development. In this article, we will discuss the main causes of FD.

  1. Bacterial infections: The most common cause of FD is bacterial infections, particularly Staphylococcus aureus. This bacterium is commonly found on the skin and can cause skin infections. In FD, the bacterium invades the hair follicles, causing inflammation and pustules. Antibiotic therapy is usually used to treat bacterial infections, but in some cases, the bacteria may become resistant to antibiotics.
  2. Hormonal imbalances: Hormonal imbalances can also contribute to the development of FD. Androgens, which are male hormones, play a significant role in the regulation of hair growth. An increase in androgens can cause an overproduction of sebum, leading to the formation of comedones and the growth of bacteria. Hormonal imbalances can also result from conditions such as polycystic ovary syndrome (PCOS), adrenal gland disorders, and thyroid disorders.
  3. Immune system disorders: FD can also be caused by an underlying immune system disorder, such as lupus erythematosus or discoid lupus. In these conditions, the immune system attacks the hair follicles, causing inflammation and scarring.
  4. Trauma: Trauma to the scalp and beard area can also trigger the development of FD. This can occur from tight hairstyles, such as braids, cornrows, and weaves, which can cause traction alopecia and hair follicle damage.
  5. Genetics: FD may also have a genetic component. Some families may have a higher risk of developing FD due to a genetic predisposition.
  6. Environmental factors: Environmental factors, such as exposure to chemicals, pollutants, and radiation, can also contribute to the development of FD.
  7. Medications: Certain medications, such as corticosteroids, can cause FD as a side effect. Corticosteroids can weaken the hair follicles and increase the risk of infection.
  8. Stress: Stress can also play a role in the development of FD. Stress can weaken the immune system, making the skin more susceptible to infection and inflammation.

In conclusion, FD is a complex condition that can be caused by a variety of factors, including bacterial infections, hormonal imbalances, immune system disorders, trauma, genetics, environmental factors, medications, and stress. It is important to identify the underlying cause of FD in order to determine the best treatment plan. Treatment may include antibiotics, topical creams, immunosuppressive agents, and hair restoration surgery. In some cases, a combination of treatments may be necessary to achieve the best results. If you are experiencing symptoms of FD, it is important to seek medical attention from a dermatologist or a specialist in hair restoration.

Symptoms

The main symptoms of folliculitis decalvans are patchy hair loss, pustules, and scarring.

  1. Patchy Hair Loss: The most noticeable symptom of folliculitis decalvans is patchy hair loss. The hair loss is usually in circular or irregularly shaped patches on the scalp. The patches can range in size from a few millimeters to several centimeters. Hair loss can also be accompanied by redness and swelling in the affected area.
  2. Pustules: Pustules are small, pus-filled bumps that form at the hair follicles. They can be red, painful, and itchy. Pustules can be a sign of infection, and they can be a source of discomfort for those with folliculitis decalvans. The pustules can be accompanied by crusting and scaling of the skin, which can lead to scarring.
  3. Scarring: Scarring is a common symptom of folliculitis decalvans. The scarring can be seen as raised, red or white marks on the skin. The scarring can be permanent, and it can lead to further hair loss. The scarring can also cause disfigurement and can be psychologically distressing for those with the condition.
  4. Pain: Pain can be a symptom of folliculitis decalvans. The pain is usually a result of inflammation and infection of the hair follicles. The pain can be mild or severe, and it can be accompanied by itching and tenderness in the affected area.
  5. Itching: Itching is a common symptom of folliculitis decalvans. The itching can be mild or severe, and it can be accompanied by redness and swelling in the affected area. The itching can be a source of discomfort for those with the condition, and it can lead to further hair loss if the affected area is scratched excessively.
  6. Swelling: Swelling is a common symptom of folliculitis decalvans. The swelling can be seen as red, raised areas on the skin. The swelling can be painful and itchy, and it can lead to further hair loss if not treated properly.
  7. Crusting and Scaling: Crusting and scaling are common symptoms of folliculitis decalvans. The crusting and scaling can be seen as dry, flaky, or scaly patches on the skin. The crusting and scaling can be a source of discomfort for those with the condition, and they can lead to further hair loss if not treated properly.
  8. Redness: Redness is a common symptom of folliculitis decalvans. The redness can be seen as a reddish-pinkish hue on the skin, and it can be accompanied by swelling, itching, and pain in the affected area. The redness can be a source of discomfort for those with the condition, and it can lead to further hair loss if not treated properly.
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In conclusion, the main symptoms of folliculitis decalvans are patchy hair loss, pustules, scarring, pain, itching, swelling, crusting and scaling, and redness. These symptoms can be distressing for those with the condition, and they can lead to further hair loss if not treated properly

Diagnosis

Diagnosis of Folliculitis Decalvans

The diagnosis of FD is typically made based on a combination of clinical presentation, medical history, and laboratory testing. The following are the main lists of diagnosis and tests for FD:

  1. Clinical Presentation: The first step in diagnosing FD is to assess the affected areas of the skin and look for the typical signs and symptoms of the condition. This includes:
  • Inflammation and redness of the skin
  • Pustules or small pimple-like bumps
  • Scaling and crusting of the skin
  • Hair loss or thinning of the hair
  • Scarring of the skin
  • Persistent itching and discomfort
  1. Medical History: The next step is to take a thorough medical history and ask the patient about any underlying medical conditions, allergies, and medications they may be taking. This information can help to rule out other potential causes of hair loss and skin irritation.
  2. Physical Exam: A physical exam is performed to assess the affected areas of the skin and determine the extent and severity of the condition. During the exam, the doctor will also look for any other signs of skin disease or infection.
  3. Microscopic Examination: A skin sample may be taken for microscopic examination to rule out other conditions such as fungal infections, psoriasis, or seborrheic dermatitis.
  4. Culture: A culture of the affected skin may also be taken to identify any underlying bacterial or fungal infections that may be contributing to the condition.
  5. Biopsy: In some cases, a biopsy of the affected skin may be performed to confirm the diagnosis of FD. A biopsy involves removing a small sample of skin for further examination under a microscope.
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Tests for Folliculitis Decalvans

  1. Blood Tests: Blood tests may be performed to rule out other potential causes of hair loss and skin irritation. This may include tests for autoimmune diseases such as lupus or rheumatoid arthritis.
  2. Skin Scraping: A skin scraping may be performed to rule out fungal infections such as ringworm.
  3. Wood’s Lamp Examination: A Wood’s Lamp examination may be performed to detect any underlying fungal infections. During this test, a special type of ultraviolet light is used to highlight any fungal growth on the skin.
  4. Skin Patch Test: A skin patch test may be performed to determine if the patient has an allergy to any specific substances. This test involves applying a small amount of a suspected allergen to the skin and observing for any adverse reactions.
  5. KOH Preparation: A KOH (potassium hydroxide) preparation may be performed to rule out fungal infections. During this test, a small sample of the affected skin is mixed with KOH and examined under a microscope for any fungal growth.
  6. PCR Test: A PCR (polymerase chain reaction) test may be performed to identify any underlying bacterial infections. This test involves amplifying the DNA of the bacteria in the affected skin sample to identify the specific species of bacteria present.

Treatment

Folliculitis decalvans (FD) is a chronic and progressive type of hair follicle inflammation that can lead to scarring and permanent hair loss. The condition is caused by a bacterial infection and can be difficult to treat due to its recurrent nature. There are several treatments available for FD, including topical, oral, and surgical options.

  1. Topical Antibiotics

Topical antibiotics such as clindamycin and erythromycin are commonly used to treat FD. These medications work by killing the bacteria that cause the infection and reducing inflammation. Topical antibiotics are usually applied to the affected area twice daily for 4-6 weeks. This treatment is effective in controlling the symptoms of FD, but it may not cure the condition completely.

  1. Oral Antibiotics
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Oral antibiotics such as tetracycline, doxycycline, and minocycline are also commonly used to treat FD. These medications work by suppressing the growth of bacteria and reducing inflammation. Oral antibiotics are usually taken for several months to a year to control the symptoms of FD. This treatment is effective in controlling the symptoms of FD, but it may not cure the condition completely.

  1. Corticosteroids

Corticosteroids are a type of medication that can help reduce inflammation and swelling. They can be applied topically or taken orally to treat FD. Topical corticosteroids are usually applied to the affected area twice daily for 4-6 weeks. Oral corticosteroids are usually taken for several weeks to control the symptoms of FD. This treatment is effective in controlling the symptoms of FD, but it may not cure the condition completely.

  1. Isotretinoin

Isotretinoin is a type of oral medication that is used to treat severe acne. It is a powerful medication that works by reducing the amount of oil produced by the sebaceous glands. This medication is sometimes used to treat FD due to its ability to reduce the amount of bacteria on the skin. Isotretinoin is usually taken for several months to a year to control the symptoms of FD.

  1. Surgical Treatments

Surgical treatments are usually reserved for severe cases of FD that have not responded to other treatments. Surgical treatments include excision, skin grafting, and hair transplantation. Excision involves removing the affected area of skin and stitching the remaining skin together. Skin grafting involves removing a piece of skin from another part of the body and using it to cover the affected area. Hair transplantation involves removing hair follicles from one part of the body and transplanting them to the affected area. These treatments are effective in controlling the symptoms of FD, but they may not cure the condition completely.

  1. Photodynamic Therapy

Photodynamic therapy (PDT) is a type of treatment that uses light and a photosensitizing agent to destroy bacteria on the skin. This treatment is effective in controlling the symptoms of FD and may be used in combination with other treatments. PDT is usually performed in a dermatologist’s office and involves applying a photosensitizing agent to the affected area and exposing it to light.

  1. Antifungal Treatments

Antifungal treatments are sometimes used to treat FD if a fungal infection is suspected. These medications work by killing the fungus and reducing inflammation. Antifungal treatments are usually applied topically or taken orally for several weeks to control the symptoms of FD.

  1. Supplements

Supplements such as omega-3 fatty acids, vitamin D, and biotin are sometimes used to treat FD. These supplements are thought to improve the health of the skin and hair.

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References