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Folliculitis decalvans

Lynne J Goldberg, MD
Section Editor
Maria Hordinsky, MD
Deputy Editor
Abena O Ofori, MD


Folliculitis decalvans (FD) is a rare, chronic cicatricial (scarring) alopecia that classically presents as an expanding patch of alopecia with peripheral pustules on the scalp (picture 1A-B). The cause of FD is unknown; it is speculated that the disease reflects an abnormal response to bacteria, particularly Staphylococcus aureus.

FD usually occurs in adults. In addition to hair loss and pustular lesions, affected patients may experience associated pruritus or pain. Systemic antibiotic therapy is the mainstay of treatment. The response to treatment is variable and relapse is common.

The clinical features, diagnosis, and management of FD will be reviewed here. Other cicatricial alopecias are reviewed separately. Of note, FD is distinct from keratosis follicularis spinulosa decalvans, a rare genetic disorder characterized by keratotic follicular papules and cicatricial alopecia. (See "Evaluation and diagnosis of hair loss", section on 'Cicatricial alopecia'.)


Folliculitis decalvans (FD) is classified as a primary cicatricial alopecia, a group of disorders in which an inflammatory process targets the hair follicle, resulting in follicular destruction and permanent hair loss. This is in contrast to secondary cicatricial alopecia, in which scarring processes in the skin incidentally destroy hair follicles. FD was further classified as a primary neutrophilic cicatricial alopecia in a classification scheme created by the participants of a 2001 workshop on cicatricial alopecia sponsored by the North American Hair Research Society [1]. This classification system was based upon the type of inflammatory infiltrate associated with specific subtypes of cicatricial alopecia. The classification of cicatricial and noncicatricial alopecias is reviewed in detail separately. (See "Evaluation and diagnosis of hair loss", section on 'Classification'.)

Although the term "folliculitis decalvans" was coined by Brocq in 1905 [2], earlier reports of what was likely FD date back to the late 1800s [3,4]. For several decades, there was much diagnostic confusion between FD and other cicatricial alopecias [5].

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Literature review current through: Nov 2017. | This topic last updated: Oct 03, 2016.
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