Folliculitis decalvans and dissecting vellulitis

Folliculitis decalvans and dissecting cellulitis are types of scarring alopecia that involve an abnormal immune response to the normal scalp flora. A common feature of folliculitis decalvans is tufted folliculitis, with embedded hairs exhibiting polytrichia. In dissecting cellulitis, patients develop boggy, inflamed cysts across the scalp.

Combination therapy is typically used to treat folliculitis decalvans and dissecting cellulitis, targeting the Staphylococcus aureus infection. This may involve combining anti-staphylococcal antibiotics such as erythromycin, cephalosporins, trimethoprim/sulfamethoxazole, clindamycin, or a fluoroquinolone with rifampin for added efficacy. Topical and systemic steroids have shown some effectiveness in treating folliculitis decalvans, and topical fusidic acid may also provide benefits. For severe cases, high-dose isotretinoin over a prolonged period may be recommended. In some instances, laser hair removal may be necessary to remove the offending hair and achieve long-term improvements.