Folliculitis decalvans

The term folliculitis decalvans belongs to type of alopecia that scopes a vast array of disorders characterized by irreversible damage of the hair follicle and permanent hair loss. Medical breakthroughs have been applied to understand this disease, but there is more left to be discovered about the causative factors, distinct clinical features and medical interventions of the insidious and disturbing scarring alopecia.
Folliculitis decalvans or also called tufted hair folliculitis and Quinquaud’s decalvans folliculitis is a peculiar form of alopecia or hair loss affecting the scalp. It forms a scarring baldness called cicatricial alopecia.

Although common to men, it may affect both sexes. It does not pose a big threat to health but may cause physical and mental issue due to its discomfort and disturbance to one’s body image. The etiology of this is unknown which makes it a difficult task to cure folliculitis decalvans. Studies were also conducted by the use of a vast array of topical and systemic agents including corticosteroids, retinoids, antifungals, antibiotics, as well as laser treatments but results have been relative.

Folliculitis decalvans Pathophysiology:

As mentioned, the exact cause of folliculitis decalvans but in most cases, the bacterium  Staphylococcus aureus is  isolated from the pustules it created but still the role of this bacterium is unclear. It is thought that new follicular epithelium grow around hair shafts yielding inflammation and scarring in the superficial tissue which consequently causes more hair follicle to emerge from a single opening.

Staphylococcal invasion is not the main cause but this infects the area due to the present inflammation making it worse.
In history, Folliculitis decalvans is experienced by adults. This is common to people aged from the 40 to 50 years old. Clients usually report alopecia that develops slowly in years. Common manifestations are pain, swelling, crust and scale formation on the scalp. The infection starts on one area of the scalp and eventually enlarges.

According to a study, pustules manifested by Folliculitis decalvans are a sign of bacterial superinfection. Superinfection is   cell condition by which the infected cell is co-infected by another bacterium at a later point of time. Authors of the study purport also believe that it is a strong immune reaction to degenerating follicles. Their study revealed, similar biopsies and histological examination  of the pustules are of Follicular Degeneration syndrome or pseudopelade.

Folliculitis Decalvans manifestations:

Physical examination of follicles conveys several follicles sprouting from a single opening which gives a “tufted” hair appearance. This appearance is widely referred as a doll’s hair pattern.  Redness develops on the site of the affected follicle or follicles. Affected hair follicles can also swell and form pustules. The pustule appears to be like a pimple. As tissues swell, they from crusts where the pus filled rash ooze.

The pathognomonic sign of follicultis decalvans is hair loss. The hair commonly falls out in round to oval single patches at the site of the pustules. When the hair falls out, the follicle is permanently damaged and can no longer produce new hairs. When balding occurred, the skin develops scars. As more hair follicles falls out, the client will have more scars.

Medical interventions for folliculitis decalvans include prescription of antibiotics to treat and control the infection. Culture and sensitivity test on the wound is performed to ensure that appropriate antibiotics are used. Most often, corticosteroids are used as oral and topical medication. These steroids are used to prevent, reduce and control accompanied symptoms such as redness, swelling and inflammation of the affected areas. Specific treatment for folliculitis decalvans is not yet known but there are available treatment aimed at inhibiting further injury and recurrence of the disease.

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