Information and Solutions for Men and Women

Folliculitis Decalvans

Folliculitis decalvans is a rare disorder that causes scalp lesions and permanent hair loss.

Believed to be autoimmune in nature, folliculitis decalvans is a rare inflammatory disorder that causes cicatricial hair loss. Unlike many other types of cicatricial alopecia, folliculitis decalvans occurs primarily in men. 76, 184

Symptoms of this primary cicatricial alopecia are:

  • Crops of pustules around the hair follicle185
  • Painful scalp lesions 184
  • Soft and boggy scalp in some patients 185

Bacteria, especially Staphylococcus aureus, are frequently found in folliculitis decalvans pustules and require antibiotic treatment. However, when staph infections are found typical short-term antibiotic therapy will not work and prolonged antibiotic use is required. 185

Treatments for Folliculitis Decalvans

Although some treatment options exist, unfortunately the majority of patients will not respond to them. Those that have shown at least some response are:

  • Antibiotics, especially the combination of Rifampin and Clindamycin 185
  • Antifungals 184
  • Antimicrobials, such as minocycline, a derivative of tetracycline 184
  • Fusidic acid 185
  • Laser depilation 184
  • Topical steroids 185
  • Zinc sulfate 185

In a recent 12 month clinical study, combination therapy regimes demonstrated successful lesion amelioration and sustainable hair regrowth in thirteen patients with mild to moderate folliculitis decalvans (some with bacterial infections in the scalp lesions and some with concurrent androgenetic alopecia). Patients were treated with combinations of systemic antibiotics along with oral glycyrrhizin and zinc gluconate supplementation, topical fusidic acid or mupirocin, selenium sulfide shampoo, or 10 mg/day of acitretin. The study authors suggested that combining minocycline (100 mg twice daily) with rifampicin (150-300 mg twice daily) or clarithromycin (250 mg twice a day) antimicrobial agents and early treatment can prevent permanent hair loss from folliculitis decalvans. 184

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