Folliculitis Decalvans

A 35-year-old man had a 5-year history of progressive hair loss characterized by follicular inflammation with destruction of the follicle and consequent permanent alopecia. Almost the entire scalp was involved. A few pustules were seen on examination, but the clinical picture was mostly one of scarring and irreversible hair loss.

Dr Reynold C. Wong of Sacramento, Calif, notes that a biopsy specimen revealed follicular abscesses with polymorphonuclear leukocytes and follicular remnants with scarring. The patient denied using unusual hair dressing procedures, such as very tight braiding. The work-ups were negative for tinea capitis and lupus erythematosus. The diagnosis of folliculitis decalvans was made.

The cause of folliculitis decalvans is unknown. It is likely that a deficit in the patient's immune response is a predisposing factor. Staphylococcus aureus has been found on cultures of some folliculitis decalvans lesions, but the significance of this finding is unknown. There is no definitive treatment for this condition; systemic antibiotics, systemic or topical corticosteroids, and systemic retinoids may be effective in some persons.

This patient refused all treatment, since oral and topical corticosteroids and oral antibiotics had been tried in the past without success. In addition, he believed that the extent of hair loss and scarring had stabilized during the past year.