Folliculitis Decalvans: Symptoms, Causes & Treatment

If you are experiencing a sudden and unexplained loss of hair, you may be suffering from folliculitis decalvans. This condition can cause extensive hair loss, and the cause is not always easy to determine.

In this article, we will discuss the symptoms, causes, and treatment options for folliculitis decalvans. We hope that this information will help you get on the path to recovery.

What is folliculitis decalvans?

Folliculitis is a skin ailment in which hair follicles are inflamed. It's most often caused by a bacterial or fungal infection. At first, it may appear like tiny red pimples or white-headed pimples surrounding the entire hair follicle, the tiny holes from which each hair growth takes place. The infection might spread and develop folliculitis into nonhealing, crusty sores.

Itching and pain are possible side effects of this condition. Extreme infections can result in permanent hair loss and scarring.

If you have a mild case, it will most likely clear up in a few days with basic self-care measures. You might require prescription medication if your folliculitis is severe or recurring. Tufted hair folliculitis is possibly a subset of folliculitis decalvans although tufting can be seen in other forms of cicatricial alopecia as well.

Is folliculitis contagious?

Folliculitis is not contagious. However, if people share razors, towels, hairbrushes, and other personal hygiene items, infectious agents such as bacteria and fungus may spread bacterial folliculitis.

Who can get folliculitis decalvans?

Folliculitis decalvans is most likely to affect men between the ages of 20 and 40. It can, however, occur at any age. The condition also seems to be more common in people with certain medical conditions, such as:

  • Diabetes


  • Leukaemia

  • Lymphoma

Types of folliculitis Decalvans

There are three types of folliculitis decalvans:

Type I: This is the most common type. It affects the scalp and often starts as small, red bumps. The bumps eventually turn into pus-filled sores. The hair follicles may become scarred and permanently damaged.

Type II: This type is also called “dissecting cellulitis of the scalp.” It affects the deeper layers of the skin and often starts as a pimple-like bump. The bump then turns into a deep, painful sore. The hair follicles may become scarred and permanently damaged.

Type III: This is the most severe type of folliculitis decalvans. It affects the deeper layers of the skin and often starts as a pimple-like bump. The bump then turns into a deep, painful sore. The hair follicles may become scarred and permanently damaged. This type is often accompanied by fever, chills, and general ill feelings.

Will hair grow back after folliculitis decalvans?

There is no guarantee that hair will grow back after folliculitis decalvans. The condition may cause permanent damage to the hair follicles, which can lead to permanent hair loss. If the hair follicles are not permanently damaged, there is a chance that the hair will grow back once the condition has been treated. However, it is important to note that the hair may not grow back to its original thickness or density.

What causes folliculitis decalvans?

There do not seem to be any specific risk factors for developing the condition but following can be the few causes of folliculitis decalvans:

1. Bacterial infections: Folliculitis decalvans is often caused by a bacterial infection, such as staphylococcus aureus. This bacteria can enter the skin through cuts or abrasions. It can also spread from person to person through close contact.

2. Yeast infections: Folliculitis decalvans can also be caused by a yeast infection. This type of infection is often seen in people who have diabetes or are taking antibiotics.

Antibiotics can kill the good bacteria that normally live on the skin. This can allow the yeast to overgrow and cause an infection.

3. Exposure to unchlorinated water in hot tubs: This can allow bacteria to enter the hair follicles and cause an infection.

4. Ingrown hairs: An ingrown hair can occur when a hair follicle becomes trapped under the skin. This can happen if you shave or wax your hair. The trapped hair may then become infected with bacteria.

5. Weakened immune system: If you have a weakened immune system, you may be more likely to get folliculitis decalvans. This can be caused by conditions such as HIV/AIDS, diabetes, or cancer.

6. Autoimmune disorders: Autoimmune disorders, such as alopecia areata, can also cause folliculitis decalvans. In these disorders, the body’s immune system attacks the hair follicles. This can lead to inflammation and hair loss.

7. Stress: Stress can also be a trigger for folliculitis decalvans. When you’re under stress, your body may not be able to fight off infections as well.

8. Harsh chemicals: Harsh chemicals, such as those found in certain hair dyes and permanents, can also damage the hair follicles. This can make them more susceptible to infection.

9. Tight clothing: Tight clothing can also irritate the skin and make you more likely to get folliculitis decalvans.

10. Obesity: Obesity can also contribute to folliculitis decalvans. This is because the extra weight can put pressure on the skin and hair follicles. This can make them more likely to become irritated and infected.

What are the symptoms of folliculitis decalvans?

Folliculitis Decalvans symptoms hair

The symptoms of folliculitis decalvans can vary depending on the type and severity of the condition. The most common symptoms are:

1. Patches of hair loss: Hair loss is the most common symptom of folliculitis decalvans. The hair loss may be patchy or diffuse. It can occur on the scalp, eyebrows, or other areas of the body.

2. Clusters of pustules around bald patches: Pustules are small, pus-filled bumps. They often form around bald patches on the scalp.

3. Redness: The skin may be red and inflamed. This is often seen in people with type II or type III folliculitis decalvans.

4. Itching: The skin irritation may start to happen. This can be a symptom of all types of folliculitis decalvans.

5. Swelling of the scalp: The scalp folliculitis may cause the skin to be swollen and tender. This is often seen in people with type II or type III folliculitis decalvans.

In addition to the scalp, you might have symptoms of this condition on your:

  • arms

  • face (more common in men)

  • chest

  • legs

  • pubic region

How is folliculitis decalvans diagnosed?

A dermatologist, usually a doctor that specializes in skin diseases, diagnoses and treats folliculitis decalvans. Folliculitis decalvans is usually diagnosed with a physical examination, which includes looking at the skin, thinning hair areas, and pustules.

The following are a few of the additional tests that may be utilized to assist establish or exclude other diseases:

  • The light-sensitive epidermis is transformed with a special light, the dermatoscopy. The skin is examined using a high-powered microscope with a beam of light.

  • Biopsy 

What is the treatment for folliculitis decalvans?

Treatment for folliculitis decalvans is focused on limiting the condition's progression. Treatment options might include:

1. Oral antibiotics

Antibiotics may be prescribed to help clear the infection. The most common antibiotics used to treat folliculitis decalvans are tetracyclines. These include doxycycline (Doryx) and minocycline (Minocin).

2. Topical antibiotics

Topical antibiotics may also be prescribed. These are applied directly to the skin. The most common topical antibiotic used to treat folliculitis decalvans is mupirocin (Bactroban).

3. Isotretinoin

Isotretinoin (Accutane) is a powerful medication that is used to treat severe acne. It can also be effective in treating folliculitis decalvans.

4. Photodynamic therapy

Photodynamic therapy (PDT) is a treatment that uses light and a photosensitizing agent to kill bacteria. It can be effective in treating folliculitis decalvans.

5. Steroids

Steroids may be used to help reduce inflammation. They can be taken orally or injected into the skin.

6. Surgery

In some cases, surgery may be necessary to remove the affected skin. This is usually only done in severe cases that do not respond to other treatments. For example: Hair transplantation surgery.

7. Avoiding shaving

If you have folliculitis decalvans, it’s important to avoid shaving. Shaving can irritate the skin and make the condition worse.

8. Anti-microbial shampoo:

If you have folliculitis decalvans, you may be advised to use an anti-microbial shampoo. This can help reduce the number of bacteria on the skin.

9. Light therapy 

Light therapy, also called phototherapy, is a treatment that uses ultraviolet (UV) light to kill bacteria. It can be effective in treating folliculitis decalvans.

10. Laser hair removal

Laser hair removal is a treatment that uses a laser to destroy the hair follicles. It can be effective in treating folliculitis decalvans.

11. Avoid tight clothes

It helps to reduce friction between your skin and clothing. This can help prevent the condition from getting worse.

12. Apply a warm compress

Applying a warm compress to the affected area can help reduce inflammation and pain.

Complications of folliculitis decalvans?

Folliculitis decalvans affects the skin only and does not involve other organ systems, suggesting that it is non-life-threatening. Early treatment is critical in reducing hair loss.

Complications of folliculitis decalvans include:

  • Hair loss in the afflicted regions is permanent.

  • Scarring can cause significant damage to the skin.

  • Recurrent episodes despite treatment.

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