Hair Therapy & Transplantation
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Clinical Presentation and Pathophysiology of Folliculitis Decalvans and its complications

Khera Ling^{* *}Correspondence: Khera Ling, Department of Dermatology, University of Paris, Paris, France, Email:

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Description

Folliculitis decalvans is a chronic and progressive inflammatory condition that primarily affects hair follicles, leading to scarring alopecia (permanent hair loss with scarring). Characterized by inflammation, pustules, crusting, and eventually follicular destruction, this disorder poses significant challenges in terms of diagnosis, treatment, and management. Understanding the pathophysiology, clinical presentation, diagnostic criteria, and therapeutic strategies for folliculitis decalvans is need for effectively managing this condition and improving patient outcomes.

Pathophysiology

The exact cause of folliculitis decalvans remains unclear, but several factors are believed to contribute to its development.

Bacterial infection: Staphylococcus aureus is frequently implicated in the condition. The bacteria may trigger an immune response that leads to chronic inflammation and follicular damage.

Immune response: An abnormal immune reaction to the bacterial infection may cause persistent inflammation and follicular destruction.

Genetic predisposition: Some studies suggest a genetic component, although specific genetic markers have not been definitively identified.

Follicular occlusion: Blockage of hair follicles may contribute to bacterial overgrowth and subsequent inflammation.

The inflammation in folliculitis decalvans leads to the destruction of hair follicles, resulting in scarring and permanent hair loss.

Clinical presentation

Folliculitis decalvans primarily affects the scalp but can occasionally involve other hair-bearing areas. Common clinical features include:

Pustules and papules: Inflammatory pustules and papules form around hair follicles, often with associated erythema (redness).

Crusting and scaling: The affected areas may develop yellowish crusts and scales.

Hair tufts: Hair follicles often become inflamed and grouped, leading to the appearance of “tufted” hair, where multiple hairs emerge from a single follicular opening.

Pain and itching: Patients commonly experience pruritus (itching) and tenderness in the affected areas.

Progressive hair loss: Over time, the inflammation and follicular damage lead to permanent hair loss and scarring.

The course of folliculitis decalvans can be variable, with periods of remission and exacerbation. Some patients may experience extensive and rapid hair loss, while others may have a more indolent course.

Diagnosis

Diagnosing folliculitis decalvans involves a combination of clinical evaluation, laboratory tests, and histopathological examination.

Clinical evaluation: A thorough history and physical examination are important. The presence of pustules, crusting, and tufted hair follicles, along with progressive hair loss, is indicative of the condition.

Bacterial cultures: Swabs from pustules can be cultured to identify the presence of Staphylococcus aureus or other bacteria.

Scalp biopsy: Histopathological examination of a scalp biopsy is need for confirming the diagnosis. Key findings include perifollicular inflammation, follicular destruction, and fibrosis.

Dermatoscopy: Dermatoscopy can aid in visualizing follicular changes, such as hair tufts and perifollicular scaling.

Prognosis and complications

The prognosis of folliculitis decalvans varies depending on the severity of the condition and the effectiveness of treatment. Early diagnosis and appropriate management can help control symptoms and prevent extensive hair loss. However, the condition is often chronic and relapsing, requiring long-term follow-up and maintenance therapy.

Complications of folliculitis decalvans may include:

Permanent hair loss: Scarring alopecia leads to irreversible hair loss in the affected areas.

Psychosocial impact: The visible hair loss and scarring can significantly impact self-esteem and quality of life, leading to psychological distress.

Secondary infections: Persistent inflammation and skin barrier disruption increase the risk of secondary bacterial infections.

Folliculitis decalvans is a challenging and chronic inflammatory condition that leads to scarring alopecia and permanent hair loss. Understanding the pathophysiology, clinical presentation, and diagnostic criteria is need for effective management. Treatment strategies focus on controlling inflammation, eradicating bacterial infection, and preventing further hair loss. Ongoing analysis and advancements in therapeutic options hold promise for improving outcomes and enhancing the quality of life for individuals affected by this condition. Early diagnosis, personalized treatment plans, and long-term follow-up are impotant in managing folliculitis decalvans and mitigating its impact on patients.