Summary about Disease
Folliculitis decalvans (FD) is a rare, chronic, inflammatory scalp condition that leads to scarring hair loss (cicatricial alopecia). It's characterized by inflammation around hair follicles, leading to pustules, crusts, and ultimately, destruction of the hair follicle and permanent bald patches. The exact cause is unknown, and it can be a challenging condition to manage.
Symptoms
Pustules (small, pus-filled bumps) on the scalp, often around hair follicles
Redness and inflammation of the scalp
Crusting and scaling
Itching and pain (may be mild to severe)
Progressive hair loss, resulting in smooth, shiny, bald patches (scarring alopecia)
"Tufting" of hair, where multiple hairs emerge from a single follicle
Occasional tenderness or burning sensation
Causes
The exact cause of folliculitis decalvans is unknown. It is believed to be an inflammatory reaction to the bacterium Staphylococcus aureus, or other bacteria. It's not considered to be a directly infectious disease, but rather an abnormal immune response. Factors that may contribute to its development include:
Immune system dysfunction
Bacterial infection (particularly Staphylococcus aureus)
Genetic predisposition (possibly, but not well-established)
Abnormal keratinization of the hair follicle
Medicine Used
Treatment focuses on controlling inflammation and preventing further hair loss. There is no single cure. Common medications include:
Topical Antibiotics: Such as clindamycin or mupirocin, to reduce bacterial colonization.
Topical Corticosteroids: To reduce inflammation.
Oral Antibiotics: Long-term antibiotics (e.g., tetracycline, doxycycline, clindamycin, rifampin in combination with clindamycin) to control bacterial overgrowth and inflammation.
Isotretinoin: A retinoid medication used in severe cases, but with potential side effects.
Corticosteroid Injections: Injected directly into inflamed areas to reduce inflammation.
Other Immunosuppressants: Such as dapsone, cyclosporine, or biologics (TNF-alpha inhibitors) in severe or refractory cases.
Is Communicable
No, folliculitis decalvans is not communicable. It is not contagious and cannot be spread from person to person through contact. It is an inflammatory condition, not an infection in the traditional sense.
Precautions
Gentle Hair Care: Avoid harsh shampoos, excessive washing, and vigorous scrubbing of the scalp.
Avoid Irritants: Minimize the use of hair products that may irritate the scalp.
Early Treatment: Seek medical attention early to minimize the extent of hair loss.
Follow Doctor's Instructions: Adhere to prescribed medications and treatment plans.
Manage Stress: Stress may exacerbate the condition in some individuals.
Avoid Picking or Scratching: This can worsen inflammation and increase the risk of secondary infection.
Hygiene: Keep the affected area clean to prevent secondary bacterial infections.
How long does an outbreak last?
Folliculitis decalvans is a chronic condition, meaning it can persist for months, years, or even a lifetime. Outbreaks (periods of increased inflammation and symptom severity) can last for weeks or months, even with treatment. The goal of treatment is to control these outbreaks and minimize their frequency and severity. There can be periods of remission where symptoms are minimal or absent.
How is it diagnosed?
Diagnosis typically involves:
Physical Examination: A doctor will examine the scalp for characteristic signs, such as pustules, redness, crusting, and hair loss patterns.
Medical History: A detailed history of symptoms and other medical conditions is taken.
Scalp Biopsy: A small sample of scalp tissue is taken and examined under a microscope to confirm the diagnosis and rule out other conditions. The biopsy will show characteristic inflammatory changes around the hair follicles.
Bacterial Culture: A sample from a pustule may be cultured to identify any bacteria present, such as Staphylococcus aureus.
Timeline of Symptoms
The progression of folliculitis decalvans varies, but a typical timeline might look like this: 1. Initial Stage: Small, itchy or painful pustules appear on the scalp, often resembling pimples. 2. Inflammatory Phase: The pustules become more numerous and inflamed, with redness and crusting. Itching and pain may increase. 3. Hair Loss Begins: Hair loss starts to occur around the inflamed follicles. Tufting of hair may be observed. 4. Scarring Alopecia: Over time, the inflammation destroys the hair follicles, leading to permanent bald patches. The scalp in these areas becomes smooth and shiny. 5. Chronic Course: The condition may cycle through periods of flare-ups and remission. Without treatment, hair loss can continue to progress.
Important Considerations
Early Diagnosis and Treatment: Early intervention is crucial to prevent extensive scarring and hair loss.
Chronic Condition: Folliculitis decalvans is a chronic condition that requires long-term management.
Compliance with Treatment: Adhering to prescribed medications and lifestyle modifications is essential for controlling the condition.
Psychological Impact: The disfiguring nature of hair loss can have a significant psychological impact. Support groups and counseling may be helpful.
Differential Diagnosis: It's important to rule out other scalp conditions that can mimic folliculitis decalvans, such as dissecting cellulitis of the scalp or lichen planopilaris.
Response to Treatment Varies: The response to treatment varies among individuals. What works for one person may not work for another.
Regular Follow-up: Regular follow-up with a dermatologist is necessary to monitor the condition and adjust treatment as needed.