Symptoms and treatment of folliculitis decalvans

1. Causes
2. Symptoms
3. Diagnostics
4. Treatment
5. Prevention

Folliculitis decalvans is a rare form of staphylococcal lesion of the hair follicle. The disease is progressive and provokes the formation of follicles without pronounced pustulization. It is characterized by the appearance of scars, skin atrophy and persistent baldness. The pathology was first identified in 1888 and called “destructive folliculitis of the pilar regions.” The etiology and pathogenesis of Quinquad are not well understood, and its exact prevalence is unknown. However, this happens quite rarely - 11% of all cases.

The disease mainly affects young and middle-aged men. Most often found in Africans. The pathological process occurs in the mustache and beard area, in the temporal areas of the scalp, and rarely in the armpits and pubic area. The disease affects women at the age of 30-60 years, but rarely and mainly in the scalp area. Cases of the disease in early childhood are very rare.

Causes of folliculitis decalvans

Pictured is folliculitis decalvans

Folliculitis decalvans is formed as a result of infection of the hair follicles, sometimes due to injuries to the scalp. However, the exact reasons for its occurrence have not been established. There are suggestions that pathologies in the body contribute to this, and some studies highlight the possibility of a seborrheic condition. However, unlike seborrheic folliculitis, decalvating folliculitis is a rare disease, so their combination has not been confirmed. The microbial factor is only one of the pathogenetic links in the development of the chronic process.

The main factors predisposing to the development of the disease are weakened immunity and systemic skin diseases, which reduce the body's resistance to infections. Such ailments include diabetes mellitus, chronic nephritis, dysproteinemia and others. There is also a theory that one of the causes of its occurrence is human skin or systemic pathology.

Symptoms of folliculitis decalvans

The clinical picture of folliculitis decalvans develops on the scalp. Lesions appear on the top and back of the head, in the temporal and dark areas along the hair growth. Sometimes follicles in other areas of the body can be affected - the axillary and pubic areas.

The onset of the disease is characterized by the formation of follicular nodules. The rash is painless, develops slowly and has a chronic course, so it can remain unnoticeable for a long time. The size of the nodules varies from 1 to 5 mm, and hair growth is observed in their center. However, pustules appear repeatedly, which destroys the hair follicles. The rash is sometimes surrounded by a halo of hyperemic skin. The nodule can exist for a long time without changes and not turn into a pustule. But some still transform into a pustule, resulting in acne pustulosis.

In the center of the rash, scar atrophy gradually forms, where baldness develops. After some time, the lesions merge, forming a large area of ​​scarring alopecia, and the borders of the lesion form new round or oval pink or ivory nodules. At times, the formation of new nodules slows down, but sometimes there is an exacerbation. Often the disease is accompanied by the appearance of lupoid sycosis on the face, which affects the skin of the ears and forehead, and after healing leaves dense scars.

Diagnosis of folliculitis decalvans

Diagnosis of folliculitis decalvans is complicated by the fact that in the early stages the disease is similar to other skin diseases. First of all, it is necessary to differentiate sycosiform folliculitis from pathologies manifested by chronic inflammation of the hair follicles. Therefore, at the initial stage of the disease, while there are no foci of atrophy, it is necessary to distinguish sycosiform folliculitis from sycosis vulgaris and mycosis of the skin.

Therefore, a diagnosis of folliculitis decalvans can be established after a dermatological examination of the scalp. Histological examination will significantly help the diagnosis. Samples are taken from tissue from the intact pustule for bacterial and fungal testing. This will allow you to isolate staphylococcus and determine the sensitivity of bacteria to antibiotics. Histology for sycosiform folliculitis will show:

1. In the epidermis there is focal follicular keratosis, in which acanthosis is expressed.
2. The spinous layer of the cell is altered, and a sign of vacuolar dystrophy is found in the lower row.
3. The mouth of the hair rash is enlarged and filled with horny masses.
4. In the dermis there is a dense infiltrate: perifollicular, lymphohistiocytic, neutrophils and mast cells can be observed less frequently.
5. Material taken from an area of ​​atrophied skin will show a picture of the late stage of Broca's pseudopelade.

Treatment of folliculitis decalvans

Folliculitis decalvans does not require a specific treatment method. This is a chronic disease that is completely incurable. At the same time, proper treatment will improve the condition of the skin and hair, and also reduce the frequency of relapses. The disease is treated with systemic and local therapy. Systemic antibacterial agents are used: Erythromycin, Cephalosporin, tetracycline drugs. Significant improvement is observed when taking antibiotics. However, relapse often occurs after therapy. Therefore, today they use combination treatment with Clindamycin and Rifampicin. This avoids the emergence of resistance to Rifampicin, which occurs after the use of this antibiotic as monotherapy. Patients are also prescribed short courses of topical steroids, which, in combination with antibiotics, relieve inflammation and signs of remission.

Folliculitis decalvans is treated locally with antibacterial shampoos containing ketoconazole. Traditional methods of treatment are used simultaneously with taking antibiotics. Burdock root ointment is used for phototherapy. To do this, 100 g of fresh root is boiled for 5 minutes in 500 ml of water. Leave for 2 hours and mix the infusion with lard to obtain a paste consistency. The mixture is placed in a container, covered with a lid and placed in the oven at 100°C for 3 hours. Cool the ointment in the oven. Apply it to the affected areas 2 times a day.

Prevention of folliculitis decalvans

Prevention of folliculitis decalvans is timely treatment. An advanced disease lowers the body's immune status. In this case, the prognosis for full recovery is unfavorable. The disease will last for years and often recur.