Folliculitis Decalvans

Folliculitis decalvans is a chronic inflammatory type of scarring alopecia that leads to irreversible hair loss in the affected areas of the scalp. While it more commonly affects young men, women can also develop this condition. It occurs when the immune system reacts abnormally, damaging hair follicles and causing permanent scarring.

The exact cause is still unknown. However, a combination of genetic predisposition and external factors is believed to play a role. The presence of certain microorganisms and the balance of the scalp microbiome are considered particularly important in the development of the disease. Despite its name, folliculitis decalvans is not contagious.

Symptoms and Diagnosis

This condition typically begins with symptoms such as itching, burning, or discomfort on the scalp. It progresses through active flare-ups, alternating with periods of remission. During these flares, the scalp may become red, develop yellowish crusts and pustules, and show hair growing in clusters—often described as “tufted hair” or “doll’s hair” pattern.

Unfortunately, diagnosis is often delayed due to its rarity and its similarity to more common scalp conditions in the early stages, such as seborrheic dermatitis. Diagnosis should be performed by a dermatologist with experience in hair disorders. Digital trichoscopy is a key tool in identifying specific patterns of the disease. In some cases, a scalp biopsy may be necessary to confirm the diagnosis and support clinical research.

Treatment and Management

Early identification of flare-ups is essential to prevent further follicular damage. During active phases, various treatments can help control inflammation and stabilize the condition. In remission periods, personalized care routines may help maintain scalp health and extend periods of stability.

Treatment approaches often include targeted topical products such as lotions or shampoos, in-office procedures (e.g., localized anti-inflammatory injections), and customized care plans based on the severity and progression of the disease.

Newer advanced immunomodulatory therapies are showing growing evidence of effectiveness in managing folliculitis decalvans.

Ongoing dermatological monitoring is crucial to adjust treatment as needed and to minimize the impact of the condition on the patient’s quality of life.