Folliculitis decalvans is a disease that causes permanent hair loss and scarring. It begins with pimple eruptions and bacterial invasion, often caused by Staphylococcus aureus. Treatment includes oral corticosteroids and antibiotics, and in severe cases, long-term antibiotic use.
Folliculitis decalvans, also known as scarring alopecia, is an infection-like disease of the hair follicles that can produce permanent hair loss and scarring. The triggers are relatively unknown, although cultures of pus-filled pimples, or pustules, surrounding affected follicles generally produce bacterial colonies. Treatment of folliculitis depends on the severity of the condition and generally includes oral corticosteroids and antibiotics.
Both men and women can develop folliculitis decalvans anytime from adolescence to middle adulthood, despite being otherwise healthy. The disorder begins with pimple eruptions, which include hair follicles. Eventually neutrophilic inflammation follows, caused by bacterial invasion. In most cases, colonies of Staphylococcus aureus are present, but other strains of the bacteria could also contribute to the condition. The affected area typically becomes red, may be swollen, and is often itchy or uncomfortable. The pustules usually rupture, ooze fluid, then form scabs.
The condition eventually destroys the hair within the follicle, leaving a scar and inhibiting future hair growth. The affected area of the scalp often resembles the bristles of a hairbrush, as bald patches mix with follicles containing more hair. Under these circumstances, the condition could be referred to as quilted folliculitis. Other times, folliculitis decalvans produces larger, more noticeable, rounded, or ovoid bald spots. The condition can be self-limiting in a small locality or spread widely to surrounding areas.
In progressive cases, bald, scarred patches of scalp may be visible, surrounded by the active disease process. The densely populated scalp region is typically the most common site for the dermatological disorder, but the condition is not necessarily limited to the scalp alone. Sometimes it develops in obscure places, including beards, armpits, or genitals. Folliculitis decalvans can also occur in the hair follicles of the arms or legs.
Some patients experience complete resolution of the condition without requiring medical intervention. Individuals suffering from extensive or particularly bothersome cases of folliculitis decalvans may be given a prescription for an oral corticosteroid or synthetic retinoic acid medication, which generally relieves inflammation and discomfort. Healthcare professionals or dermatologists might perform culture and sensitivity tests of lesions when infectious processes appear to contribute to or exacerbate the condition. If people are suspected to be carrying a particular bacteria, the nasal passages might also be tested.
People who have extensive bacterial involvement might be given a topical antibiotic ointment, typically applied to the affected areas and possibly the nostrils. Depending on the severity of folliculitis decalvans, doctors may also prescribe one or more oral antibiotics over a long period of time to kill the bacteria. This type of intensive care generally results in a complete and lasting resolution of the disorder.
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