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Hair loss is a common condition that affects millions of people worldwide. There are numerous factors that can contribute to hair loss, including genetics, age, hormonal changes, medications, and certain medical conditions. One specific condition that can lead to hair loss is folliculitis decalvans, a chronic inflammatory disorder that affects the hair follicles on the scalp. This condition is characterized by the development of pustules and abscesses on the scalp, which can lead to scarring and permanent hair loss in some cases. Folliculitis decalvans can be difficult to diagnose and treat, and it can have a significant impact on a person’s self-esteem and quality of life. In this article, we will explore the causes, symptoms, diagnosis, and treatment options for folliculitis decalvans, with a focus on how this condition can contribute to hair loss.
What Are The Symptoms Of Folliculitis Decalvans?
Folliculitis decalvans (FD) is a chronic inflammatory scalp condition that affects the hair follicles. The condition is characterized by inflammation in the hair follicles, leading to various symptoms such as itching, inflammation, tenderness, a tight feeling scalp, and in rare cases, no symptoms at all.
Unlike genetic hair loss, FD includes inflammatory symptoms that affect the scalp and surrounding areas. Over time, patients may notice redness, swelling, pustules (blister-like pimples that contain pus), scars, tufting of hairs, scaling, crusting, sores, and hair loss in irregular patches. These symptoms may cause discomfort and affect the appearance of the scalp, which can lead to social and psychological distress.
While the condition is most noticeable on the scalp due to the amount of hair in the area, it can also occur in other areas such as the beard, armpits, pubic areas, and legs. Hair loss in these areas can also occur, causing hair to fall out in irregular patches.
FD is a chronic condition that requires medical attention. Early diagnosis and treatment can help manage the symptoms and prevent further hair loss. If you suspect that you may have FD, it’s important to see a dermatologist who can diagnose the condition and provide appropriate treatment. Treatment options may include antibiotics, anti-inflammatory medication, and topical treatments.
What Causes Folliculitis Decalvans?
Folliculitis decalvans (FD) is a chronic inflammatory disorder that results in hair loss by causing scarring hair loss or cicatricial alopecia. FD is a form of folliculitis, which refers to the inflammation of hair follicles. While FD shares characteristics of both alopecia and folliculitis, they don’t necessarily manifest simultaneously. The exact cause of FD is not yet known.
FD is different from regular folliculitis as it obstructs hair growth. As FD progresses, hair follicles are damaged and incapable of generating new hair. The symptoms of FD typically include pustules, crusting, and sores. Scar tissue forms in the affected areas due to dead hair follicles, hindering any further hair growth.
FD can affect anyone, regardless of their general health. While middle-aged men are at a higher risk of developing FD, it can also affect both men and women as early as adolescence. Although the condition is infrequent in children, it is not contagious. Despite the absence of any other known risk factors, the precise cause of FD remains unknown.
How Is Folliculitis Decalvans Diagnosed?
If you suspect you have FD, it is important to see a dermatologist, a medical specialist who is trained to diagnose and treat skin and hair diseases.
To diagnose FD, a dermatologist will conduct a thorough examination of your scalp, skin, and hair. They will look for areas of hair thinning, pustules, and scarring. They may also take a culture and/or biopsy to aid in the diagnosis.
In addition to FD, other conditions can cause hair loss. Therefore, a dermatologist will also rule out other possible causes, such as hormonal imbalances related to pregnancy, menopause, or elevated androgen levels, recent illness or infection, an underactive thyroid (hypothyroidism), exposure to radiation, cancer treatments, certain medications, ringworm, chronic stress, trauma, malnutrition (especially iron and protein deficiencies), vitamin A overdose, weight loss, eating disorders, poor haircare, and tight hairstyles.
Once other causes have been ruled out, a biopsy and culture may be recommended to confirm the diagnosis of FD. A blood test may also be ordered to rule out any underlying medical conditions, such as thyroid disease.
Diagnosing FD can be a complex process that requires a combination of a medical history, physical examination, biopsy, blood test, and skin culture. It is important to work closely with your dermatologist to ensure an accurate diagnosis and appropriate treatment plan. Treatment options for FD may include antibiotics, anti-inflammatory medications, or topical agents. In some cases, surgery or hair transplantation may be necessary.
Treatment Options for Folliculitis Decalvans
The most effective treatment approach may vary from person to person, and a combination of two or more approaches may be necessary to manage symptoms. Here are some of the more widely used treatments:
Oral Antibiotics: Oral antibiotics are among the most common treatments for FD. Several types of antibiotics have been used with mixed results. Another combination of doxycycline or azithromycin, even when paired with corticosteroid injections and topical antibiotics, led to a shorter remission period.
Steroid Injections: Corticosteroid injections in the scalp or affected area can help reduce inflammation. This treatment is typically part of a more comprehensive treatment plan that includes oral and/or topical antibiotics. Dermatologists may also prescribe oral corticosteroids to help fight inflammation and stop the spread of FD.
Topical Treatments: Medicated shampoos and topical antibiotics can be used to treat FD but may be most effective when paired with oral antibiotics. Non-antibiotic topicals such as tacrolimus and calcipotriol may also help.
Photodynamic Therapy: Photodynamic therapy is a process that uses special lights to fight skin infections. When other treatment options aren’t effective, photodynamic therapy may be an option, especially for those who have a poor response to antibiotics.
Surgery:While medications and noninvasive therapies are the first-line approach to treating FD, hair restoration options may be considered once the condition is under control. Experts recommend hair transplant surgery only after the disease has shown no progression for a few years after the patient has stopped medication and no inflammation is found on a biopsy.