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Shampoos for Folliculitis Decalvans
There is a wide range of over-the-counter and prescription shampoos available. Consult your healthcare provider to determine the product that might work best for you.
The outlook for folliculitis decalvans is generally favorable. This condition often responds well to treatment. Results can usually deliver a noticeable cosmetic improvement.
However, folliculitis may return or spread to other body areas even if it is resolved at one site. In some people, the disease may progress slowly over time and continue to flare for months or years.
Though treatments may improve symptoms, dealing with a chronic condition that affects your appearance can be challenging. It can have a negative impact on your quality of life for the following reasons:
- Severe scarring may result in permanent hair loss in the affected sites.
- Regrowth of the hair lost to folliculitis decalvans is rarely possible.
- The side effects of long-term treatments can affect the way you feel.
- For many people, folliculitis decalvans can affect their quality of life.
- Hair transplantation to correct bald patches can't be attempted until the condition has been inactive for several years without treatment. This ensures that the problem does not recur and damage the newly transplanted hair.
If you're feeling overwhelmed by folliculitis decalvans, consider speaking to your healthcare provider or seeking mental health counseling to help you cope with your feelings.
Case presentation
A 20-year-old male from central India presented to the outpatient department of a tertiary care hospital with multiple painful pustules covering the crown and occipital areas of his scalp (Figure (Figure1). 1 ). The patient had no history of pruritus, hidradenitis suppurativa, acne, or scalp injuries. Multiple nodulocystic lesions and patches of hair loss over the occipital and crown region were noted during the clinical examination.
Figure 1
Multiple nodulocystic lesions are present on the occipital and crown area of the scalp (black arrows).
All laboratory tests, such as the fasting lipid profile, thyroid profile, liver function test, renal function test, total blood count, and other indicators of inflammation, were within normal ranges. No fungal growth was seen in the fungal culture. Methicillin-sensitive S. aureus was found in moderate amounts in the swabs taken from the intact pustules. Methicillin-sensitive S. aureus was also detected in pustule scalp bacterial cultures (Figures (Figures2, 2 , ,3 3 ).
Figure 2
Round (1-3 mm), golden-yellow colonies of Staphylococcus aureus on blood agar.Figure 3
Yellow-colored colonies of Staphylococcus aureus on mannitol salt agar (MSA).A diagnosis of FD was made for the patient based on the clinical presentation, examination, and culture results. The patient was prescribed topical ozenoxacin 2% lotion twice daily for one month and oral doxycycline 100 mg BD. At one-month follow-up, the patient showed a recession of nodulocystic lesions with reticular patches of alopecia and hair regrowth (Figure (Figure4 4 ).
Introduction
Acne keloidalis nuchae (AKN) also known as folliculitis keloidalis nuchae (FKN) is one of the chronic forms of scarring folliculitis seen mostly in men of African descent. 1 Although the term “folliculitis keloidalis nuchae” captures the follicular nature of the disorder and is preferred by some, the lesions develop past the nuchal area suggested by the terminology. The term AKN is commonly used although it is generally agreed that the condition is not a keloid, and affected individuals do not have a tendency to develop keloids in other areas of the body. Acne keloidalis (AK) lesions do not have histological features suggestive of a keloids. 2
Hebra in 1860 first used the terminology sycosis framboesiformis although it had been described as a distinct entity in the late 1800s. 3 In 1869, Kaposi referred it to as dermatitis papillaris capillitii, and in 1872, Bazin coined the term AKN. 4 The exact cause of AKN remains unknown. The inciting agents appear to be multifactorial with various factors such as androgens, inflammation, infection, trauma, genetics, and ingrowing hairs being implicated. It shares some similar features with other forms of cicatricial alopecia and may occur together in the same individual. It has been classified as a mixed form of the primary cicatricial alopecia by the North American Hair Research Society. 5 It is characterized by papules, pustules, and sometimes tumorous masses in the nuchal or occipital regions of the scalp hence the name “bumps” evolved in the environment. 6 Despite its common occurrence, treatment may be challenging. This review highlights the epidemiology, clinical features, impact, and treatment challenges.
Epidemiology
AKN occurs majorly in those of African descent. It has been reported in a few Caucasians and other ethnic groups. 7 It is predominantly a disorder of males although there are a few reports in females with a male to female ratio of 20:1. 8 , 9 Reports from Nigeria give a prevalence ranging from 0.7% to 9.4%, 10 – 12 while in Benin in West Africa the prevalence is 0.7%. 13 In South Africa, a prevalence of 4.7% was seen in boys in their last year of school and 10.5% in older men. 14 In African-Americans, the reported prevalence ranges from 0.5% to 13.6%. 5 , 16 The latter was in American footballers who wore headgears for protection. Their Caucasian counterparts wearing the same headgears did not develop AKN.
Summary
Folliculitis delcavans is a rare ailment that causes red, swollen patches on your scalp. The patches destroy your hair follicles, causing scars and permanent hair loss at the affected sites.
While there is no known cause, the problem is linked to a bad response to Staphylococcus A. bacteria. It is believed that the bacteria trigger an extreme immune response that causes symptoms.
Treatments can reduce symptoms and slow the damage to hair follicles. The nature and chronic course of this problem can also have a negative impact on those who have it. Enduring long-term treatment only to have the problem recur can be difficult. This can also have an impact on your self-image and affect your quality of life.
Working with your healthcare provider and a counselor can help you manage the mind and body aspects of this problem. Despite its long course, the outlook is good for most cases.
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- NYU Langone Health. Types of hair loss.
- British Association of Dermatologists. Folliculitis decalvans.
- Fabris MR, Melo CP, Melo DF. Folliculitis decalvans: the use of dermatoscopy as an auxiliary tool in clinical diagnosis. An Bras Dermatol. 2013,Sep-Oct,88(5):814-6. doi: 10.1590/abd1806-4841.20132129
- Penn Medicine. Folliculitis.
- The Primary Care Dermatology Society. Folliculitis decalvans.
- Rakowska A. A 36-year-old man with inflammatory lesions and crusts on the scalp. In: Waśkiel-Burnat A, Sadoughifar R, Lotti TM, Rudnicka L, eds. Clinical Cases in Scalp Disorders. Springer International Publishing, 2022:43-46.
- Coondoo A, Phiske M, Verma S, Lahiri K. Side-effects of topical steroids: A long overdue revisit. Indian Dermatol Online J. 2014,5(4):416-425. doi:10.4103/2229-5178.142483
- Pimenta R, Borges-Costa J. Successful treatment with fusidic acid in a patient with folliculitis decalvans. Acta Dermatovenerol Croat. 2019,27(1):49-50. doi:
- Le Calvé C, Abi-Rached H, Vicentini C, et al. Treatment of folliculitis decalvans by photodynamic therapy using a new light-emitting device: a case series of 4 patients. JAAD Case Rep. 2021,17:69-72. doi:10.1016/j.jdcr.2021.09.026
- Pindado-Ortega C, Saceda-Corralo D, Miguel-Gómez L, et al. Impact of folliculitis decalvans on quality of life and subjective perception of disease. Skin Appendage Disord. 2018,4(1):34-36. doi:10.1159/000478053
