How do you treat folliculitis decalvans ?

 FOLLICULITIS DECALVANS :



Folliculitis is inflammation of the hair follicle. Follicles are the bulb-shaped root that anchors hair to your scalp and generates new hair. Bacteria trapped in the inflamed hair follicle can cause small pus-filled bumps called pustules to form. These red, oozing pustules look like acne. Folliculitis decalvans is a rare condition that causes ongoing (chronic) inflammation  of your hair follicles and scalp. Over time, hair falls out and scarring occurs. The condition causes permanent hair loss with scarring . 

 Folliculitis decalvans, a condition that causes baldness with scarring (cicatricial alopecia). Inflammation and bacteria in hair follicles cause pustules to form. Hair follicles eventually die, preventing new hair growth and causing circular bald patches. Treatments include antibiotics and photodynamic therapy.

FD stems from widespread inflammation within the hair follicles. This causes the follicles to lose hair and stop producing new ones. It can also lead to other inflammatory symptoms. FD stems from widespread inflammation within the hair follicles. This causes the follicles to lose hair and stop producing new ones. It can also lead to other inflammatory symptoms.

WHAT ARE THE CAUSES OF FOLLICULITIS DECALVANS ?

Folliculitis decalvans can cause permanent hair loss in women and men. It more often affects men and people assigned male at birth. It often starts during the teen years or early adulthood but can develop at any time.  A staphylococcus infection (staph infection) may be to blame. Some people seem to have an unusual reaction to Staphylococcus aureus (Staph A). This bacterium is naturally found on your skin  and inside your nose. 

Staph A is usually harmless. But for some people, the bacteria causes ongoing inflammation. Over time, this inflammation destroys hair follicles, preventing them from growing new hair. Eventually, hair falls out, leaving  This hair loss (also known as alopecia) is permanent. FD is different from folliculitis because In addition to inflamed hair follicles, it can halt hair growth. As the condition progresses, your hair follicles are destroyed and can no longer produce hairs. Pustules, crusting, and sores are commonly seen. Scar tissue develops in place of dead hair follicles. This prevents any further hair growth in the affected areas.

FD can happen to anyone, even if those who are in overall good health. While middle-aged men are at greater risk of developing FD, it can affect women and men as early as adolescence. The condition is rare in children, and it’s not contagious. However, no other risk factors are known and there’s likely no single cause of FD. FD is a chronic inflammatory disease that leads to hair loss. It is a type of folliculitis, a term used to describe inflammation of hair follicles. It’s classified as a form of alopecia called cicatricial alopecia or scarring hair loss, where hair follicles are replaced with scar tissue.

While FD has components of both alopecia and folliculitis, they don’t always occur at the same time. 

WHAT ARE THE SIGNS AND SYMPTOMS  OF FOLLICULITIS DECALVANS ?



Folliculitis decalvans typically affects only your scalp, causing round or oval-shaped bald spots. Rarely, hair loss occurs in other regions. It can affect your armpits, genitals, face, legs and arms.

Some people don’t have noticeable symptoms until they begin to lose hair. Others may have an itchy scalp that feels like dandruff . Folliculitis decalvans causes hair to grow in tufts. Several strands of hair grow from the same follicle, like bristles on a toothbrush. For this reason, the condition is also called tufted folliculitis. When the follicle dies, the tufts of hair fall out, leaving a scar and bald spot.

The scalp may feel tight or painful. Pustules most commonly appear on the back of your head but can occur anywhere on your scalp. You may feel scaly skin or crusts after the pustules ooze and form scabs. Inflammation in the hair follicles eventually leads to a variety of noticeable symptoms. FD may cause itching, inflammation, tenderness, tight feeling scalp, and, rarely, you may have no symptoms at all. Unlike genetic hair loss in which you might only experience hair thinning, FD also includes inflammatory symptoms. Hair loss from this condition often occurs in irregular patches.

Alopecia is perhaps most noticeable on the scalp because that’s the area of the body with the most hair. However, alopecia can occur in the following areas:

  • beard
  • armpits
  • pubic areas
  • legs

FD can develop in these same areas as well.

HOW IS FOLLICULITIS  DECALVANS DIAGNOSED ?

A medical doctor who specializes in the diagnosis and treatment of skin conditions, will examine your scalp. Your provider may use a magnifying device to view the pustules more clearly. 

  • Take a swab of the pustule fluid to check for the presence of Staph A.
  • Pluck a few strands of hair and take skin scrapings from the scalp to test for ringworms. This fungal infection causes similar symptoms.
  • Perform a skin biopsy to confirm the diagnosis.

FD is diagnosed and treated by a dermatologist. This type of medical doctor specializes in diseases of the hair and skin. Depending on your insurance, you may need a referral from your primary care doctor if you haven’t seen a dermatologist for this condition before. Your primary care doctor will perform a physical exam of the patches in question and make this determination.

A dermatologist will thoroughly examine your scalp, skin, and hair. They’ll examine the skin and note any rashes or scarring. Additionally, they’ll look at areas of pustules and thinning hair and may take a culture and/or biopsy. 

other causes for your hair loss are ruled out, a dermatologist might recommend a biopsy and culture. This procedure involves taking a small sample of your scalp or your skin and sending it to a lab for testing. A blood test may also be ordered to help rule out any other underlying issues, such as thyroid disease .

Other possible causes for your hair loss

A dermatologist may rule out other causes of hair loss, such as:

  • hormonal conditions related to pregnancy, menopause and elevated androgen levels
  • a recent acute illness, such as the flu or an infection
  • underactive thyroid (hypothyroidism)
  • radiation exposure
  • cancer treatments
  • certain medications, such as birth control pills anabolic steroids, and blood thinner
  • ringworm
  • chronic stress
  • stress from a recent traumatic event
  • malnutrition
  • weight loss
  • poor haircare
  • tight hairstyles
HOW TO TREAT FOLLICULITIS DECALVANS ?

There is currently no cure for FD. The main goals of treatment are to reduce inflammation and prevent the condition from getting worse. Because FD is a rare condition, most treatment studies have been small, with no overwhelming consensus about the most effective option.



Some treatments are more effective for certain people than they are for others. You may need to pursue a variety of treatment options or a combination of two or more approaches to manage your symptoms. Among the more widely used treatments are:

Oral antibiotics

Several types of antibiotics are used to treat FD, most with mixed results. A 2019 review of multiple FD studies, published in the Journal of the American Academy of Dermatology, found that one of the most effective combinations of antibiotics was a 10-week course of clindamycin and rifampicin. The treatment was associated with a remission phase of 7.2 months.

That same review found that another combination — doxycycline or azithromycin — led to a shorter remission period, even when corticosteroid injections and topical antibiotics were added to treatment.

Steroid injections

One way to help reduce inflammation is with corticosteroid injections in the scalp or other area affected by FD. The use of steroids is typically part of a more comprehensive treatment plan involving oral and/or topical antibiotics.

Your dermatologist may also prescribe oral corticosteroids to help fight inflammation and stop the spread of FD.

Topical treatments

Medicated shampoos and topical antibiotics are commonly used to treat FD but may be most effective when paired with oral antibiotics. There are also non-antibiotic topicals such as tacrolimus and calcipotriol that may help.

Photodynamic therapy

The use of special lights to fight skin infections — a process called photodynamic therapy — may be an option for people when other treatment options aren’t effective, especially for those having a poor response to antibiotics. A 2021 study found that photodynamic therapy is not only an effective option for some people with FD but may also fight FD flare-ups.

Surgery

While medications and noninvasive therapies are the first line approach to treating FD, once the condition is under control you may want to consider hair restoration options. Many 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.

For some people with partial hair loss, a doctor can harvest healthy hair from part of the scalp and graft it onto an area of the scalp that is bald. A 2019 studyTrusted Source suggests that hair transplants can often be successful for people with a range of hair loss conditions, including folliculitis decalvans.

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