Folliculitis Decalvans & Dissecting Cellulitis: Causes, Symptoms & Treatment | Dr. David Bryant

What is Folliculitis Decalvans (FD)?

FD is a chronic inflammatory disorder affecting hair follicles, usually starting as small pustules and crusted bumps on the scalp. Over time, it can destroy hair follicles, leaving smooth, scarred patches.

Key Points: Folliculitis Decalvans

• Triggered by an abnormal immune response to bacteria, often Staphylococcus aureus

• Causes localized scarring alopecia

• More common in middle-aged men, but can affect anyone

• Chronic and requires long-term management

Symptoms:

• Painful pustules or abscesses on the scalp

• Crusting and oozing in affected areas

• Progressive hair loss with scarring

• Redness and inflammation around follicles

What is Dissecting Cellulitis of the Scalp (DCS)?

DCS is a painful, chronic inflammatory condition often associated with FD and other follicular occlusion disorders such as hidradenitis suppurativa. It presents as boggy nodules, pus-filled abscesses, sinus tracts, and scarring.Folliculitis Decalvans.

Symptoms:

• Painful lumps on the scalp, often on the crown

• Pus-filled abscesses that may connect, forming sinus tracts

• Hair loss in affected areas, sometimes with hair remaining between lesions

• Chronic inflammation and scarring

Risk Factors:

• Young adult Black males are more commonly affected

• Blocked hair follicles and ruptured follicles triggering inflammation

• Associated with other follicular disorders like acne conglobata or hidradenitis suppurativa

Diagnosis -Folliculitis Decalvans

Diagnosis typically involves:

• Clinical examination of pustules, scarring, and scalp lesions

• Scalp biopsy to confirm follicular destruction and inflammation

• Trichoscopy revealing yellow dots (cysts) and black dots (destroyed hairs)

Accurate diagnosis is critical, especially for Black and ethnic skin, as inflammation may appear differently than in lighter skin tones.

Treatment and Management -Folliculitis Decalvans

While there is no permanent cure, treatments focus on controlling inflammation, managing infection, and preventing further hair loss.

Medical Treatments -Folliculitis Decalvans

• Antibiotics: Long-term oral antibiotics (doxycycline, minocycline, rifampin/clindamycin) to control infection and inflammation

• Retinoids: Oral isotretinoin for severe or refractory cases

• Topicals: Steroids, antiseptic washes like chlorhexidine

• Biologics: TNF inhibitors or IL-17/IL-23 inhibitors for severe chronic cases

Procedural and Surgical Options -Folliculitis Decalvans

• Laser hair removal or photodynamic therapy for targeted inflammation control

• Surgical excision (scalpectomy) with skin grafting for severe, recalcitrant cases

Self-Care and Lifestyle Measures

• Avoid picking or squeezing lesions

• Use antiseptic shampoos and avoid oil-based hair products

• Quit smoking and maintain scalp hygiene

• Follow dermatologist-prescribed treatment plans consistently

Prognosis

FD and DCS are chronic, difficult-to-treat conditions:

• Medications work gradually; relapses are common if treatment is stopped

• Surgical options can provide durable resolution in severe cases

• Early intervention is crucial to prevent permanent hair loss and scarring

When to See a Dermatologist

Consult a dermatologist if you experience:

• Chronic scalp pustules or abscesses

• Painful, boggy lumps on the scalp

• Progressive hair loss with scarring

• Ineffective results from over-the-counter treatments

Dr. David Bryant  specializes in treating FD, DCS, and scarring alopecia, with expertise in Black and ethnic skin, providing personalized treatment plans to manage chronic scalp conditions -Folliculitis Decalvans

📍 Serving patients in Decatur, Stockbridge and the greater South Atlanta area

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This article is for educational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider for diagnosis and treatment-Folliculitis Decalvans.