Folliculitis decalvans successfully treated with rifampicin and clindamycin

Abstract

Folliculitis decalvans (FD) is a rare form of neutrophilic cicatricial alopecia, first described by Quinquaud in 1888. The aetiology of FD is unclear, though Staphylococcus aureus infection and immune dysfunction are thought to be significant factors. Folliculitis decalvans primarily affects young to middle-aged adults, with a higher prevalence in men. Clinically, it is characterized by papules, pustules, alopecic patches, crusts, tufted hairs, and erosions, commonly affecting the vertex. Diagnosis is typically based on histopathological examination, though trichoscopy may suffice. Treatment is challenging due to the chronic and relapsing nature of the disease. This report presents a 33-year-old female admitted to the Dermatology Department due to scalp lesions, hair loss, and itching, which had been ongoing for 8 years. Previous treatments with topical anti-inflammatory agents, glucocorticosteroids, and oral antifungals provided temporary relief, but symptoms recurred after discontinuation. On examination, thick yellow scales, inflammation, and pustules at hair follicle openings were observed, along with hair thinning in the parietal region. Videotrichoscopy revealed perifollicular scaling, large hair tufts, and pustules. A culture-confirmed Staphylococcus aureus, while mycological tests were negative. Histopathology showed chronic folliculitis with suppuration and fibrosis. The patient was treated with clindamycin and rifampicin, along with topical therapy. A follow-up showed partial improvement, with a resolution of pustules and scales, though hair thinning and scarring persisted. This case underscores the importance of early diagnosis and long-term management to prevent irreversible damage. Regular monitoring is essential due to the potential risk of squamous cell carcinoma.