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Folliculitis Decalvans


There are many different kinds of folliculitis that can afflict people of all ages and from all walks of life. Some are easier than others to treat, but one of the most difficult forms of folliculitis to treat is also one of the rarest and most troubling; it is called Folliculitis Decalvans.

What is Folliculitis Decalvans?


Folliculitis Decalvans is a rare and disfiguring form of folliculitis. Very little is known about its cause, although medical research has shown that patients who suffer from this rare condition often have
Staphylococcus aureus bacteria present on their scalp and in their hair follicles, but it is not clear that the bacteria has anything to do with the condition. Where most types of folliculitis cause red bumps and infections, Folliculitis Decalvans lesions lead to permanent hair loss and disfiguring scars for those who fall victim to it. Though most cases show up on the scalp, the condition can appear anywhere on the body that has hair, including arms, legs, eyebrows and the pubic area.








Symptoms


Patients who present with Folliculitis Decalvans often have large patches of skin that have lost all of their hair, and the area is usually badly scarred. Inflamed pustules and lesions within these hairless areas often have single follicles from which several hairs are growing. This phenomena is referred to as tufted folliculitis, and it is generally the result of serious damage being done to a series of hair follicles in a single area, with several hairs ending up grouping and growing out of the single remaining undamaged follicle. The lesions often have areas of scaly grey or yellow skin surrounding them, and the surrounding area is often described as having a variety of painful looking scales, holes, eruptions and erosions. Bleeding is often reported by the patient, as well as itchiness, a sensation of burning and pain. They also report that follicles often leak a fluid that is filled with pus. As the condition spreads, alopecia, or permanent hair loss sets in and the patches generally get larger. The condition is extremely resistant to treatment.








Causes and Risk Factors


Although very little is known about what causes this condition, the presence of the staph infection as well as indications that the disease may run in families has pointed to the possibility that the condition may be genetically related, and may represent an inability to fight off the staph infection, particular in areas where there are hair follicles and sebaceous glands.







Treatment


Because this condition leads to such a dramatic change in the patient's appearance, and because people's sense of self-confidence is so tied in to their hairline, it is very important that a Folliculitis Decalvans patient's physician is both sensitive to the patient's emotions and is honest about the long term prognosis for the condition. It is essential that patients understand that any hair that they have lost is not going to regrow, and that because the condition is so difficult to treat there is a good chance that they will lose more hair before the condition is arrested. Covering up the hair loss and scarring is also very difficult, as the Staphylococcus aureus that apparently plays such a large role in the condition can live on bandannas, wigs or hats that the patient may use to cover their embarrassment.


Excellent and meticulous hygiene must be practiced, and head covering may often need to be replaced for fear of reinfection. As for medication, the most effective treatment that has been found has been a combination of Rifampin (a medication that is usually used in the treatment of tuberculosis) and Clindamycin, a powerful antibiotic. Unfortunately, though this combination is usually effective, it is also known to cause serious side effects, including problems of hepatitis and colitis. Though other antibiotics have been successful at stopping the spread of the condition, studies have shown that as soon as the patient discontinues taking these antibiotics the condition returns. In order to prevent this kind of relapse, patients may need to go on an prophylactic, low-dose course of antibiotics for a period of months or even years. Other therapies for treatment of this condition include the use of topical antibiotics, which can be effective on their own if the patient's condition is relatively mild. Topical steroids can also be effective at helping with some of the pain and itching that patients experience. Daily shampooing and cleaning with antiseptic shampoos has been shown to be helpful as well. In cases where the swelling and itching are too bad, patients are generally offered a dose of oral steroids for a short period of time. Patients who are experiencing frustration with the slow pace of recovery are often tempted to combine the treatments that they are offered to speed things up, but they are warned against doing so because the medications in combination can have dangerous side effects.


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