Folliculitis: Causes, Symptoms and Treatments

What is folliculitis decalvans?

The name folliculitis decalvans comes from the Latin term for “inflammation of the hair root associated with hair loss”. The condition is a result of chronic (long-term) inflammation on the scalp which eventually causes scar tissue to form. While it most commonly affects the scalp, it can affect other areas of the body, like the beard, the pubic region, armpits, or legs.

Scarring alopecias (hair loss) are permanent. This is because the inflammation affects the follicle, destroying it and leaving scar tissue in its place. There are two types of scarring alopecias. Primary alopecia means the inflammation is present at the follicle, secondary scarring alopecia is when the inflammation does not target the follicle specifically, but the follicle is nonetheless affected and replaced with scar tissue. In these instances, regrowth is impossible.

There are a number of conditions that result in scarring alopecia. While this condition can be deeply upsetting, understanding its cause and symptoms can help determine the best treatment protocol to curb and prevent further loss.


What causes folliculitis decalvans hair loss?

It is thought that folliculitis decalvans is caused by an abnormal inflammatory reaction to a bacterium called Staphylococcus aureus, which is normally present on healthy skin. The inflammatory reaction becomes chronic and eventually leads to scarring. This is a theory, at this point, we can’t say for certain what causes Folliculitis decalvans.

Folliculitis decalvans does not appear in more than one family member frequently enough to make any correlation. Folliculitis decalvans is not hereditary.

The symptoms of folliculitis decalvans

Sometimes there are no sensations felt. Some people say they feel an itchy sensation with a tightness and pain.

What this type of hair loss looks like

The skin or scalp will show visible signs of inflammation. Redness, swelling, scaly skin, and scabs are common. Red bumps that are puss-filled can also develop, especially to the back of the head.

Alongside this, tufting may occur. This is when several hairs fall out of one follicle, creating a bald spot which may grow over time. The alarm associated with this hair loss can have a harrowing effect on a person’s mental well-being. It is important to find a good source of emotional support.

Diagnosis of folliculitis decalvans

There are three steps to making the diagnosis. Dr. Khoza will examine the skin and take a swab of it. The swab will be sent to a lab to test for bacterial infection, it is common for the results to indicate a bacterial infection with Staphylococcus aureus.

Fungal infections, like ringworm, often show similar symptoms. To rule out a fungal infection, Dr. Khoza may take skin scrapings or pluck a hair as a sample to test.

A skin biopsy may be required. This involves a local anesthetic being injected into the area. The skin sample is examined under a microscope to confirm the diagnosis.

How is folliculitis decalvans treated?

Prevention is the best protocol. Once scarring occurs, the damage can not be reversed. That means the condition can not be cured but can be treated by lowering inflammation to prevent scarring.

In some cases, the condition can run its course while in others it becomes chronic, requiring ongoing treatment.

The condition is rare, therefore there is no patented treatment specifically for folliculitis decalvans. Rather, a combination of treatment protocols together can ease the symptoms.

We address the inflammation levels that cause the scarring, with oral antibiotics. Topical treatments involve anti-inflammatory and anti-bacterial applications and medicated shampoos. By controlling the inflammation, scarring can be avoided.

Home care

Purchasing an antiseptic shampoo, or one that contains tar, is often effective. The best way to get the results you need is to consult a Dermatologist to find the best treatment for your condition based on your symptoms.

The effects of hair loss

Hair loss can be a very distressing experience, you may feel powerless and frustrated. It is important to ensure you have a good sense of moral and emotional support, and finding a new source of confidence through hobbies or interests may help, although it can be challenging to try new things. It is important to remember your dermatologist is here to support you through this journey and find the best way to combat the symptoms. The goal is to give you the greatest chance of maintaining full and lustrous hair growth.

Hair loss and scalp disorders with Dr. Nokubonga Khoza

Our hair loss and scalp disorders consultation take about 20-30 minutes. Only conditions relating to the scalp will be discussed during this session. All patients are expected to fill out a pre-assessment form on arrival to the practice. There are many causes of hair loss and scalp disorders and surprisingly they can look similar. Dr. Khoza’s primary goal is to provide the highest level of care when it comes to skin and scalp disorders. Our hair consults focus is on proper diagnosis, non-surgical management, counselling and preventing further disease progression.

During the consultation, Dr. Khoza will review the patients past medical history, medication, hair grooming practices, and styling. She will examine the scalp with the use of dermoscopy and take relevant pictures. Should there be a need; Dr. Khoza may order blood tests, take hair samples and perform a scalp biopsy. Dr Khoza performs the following in-office procedures for hair loss; Platelet rich plasma, micro-needling and intralesional injections.

Please note all procedures are scheduled for a separate appointment and are not performed on the same day as the initial consultation.

Estimated time for procedures:

  • Scalp biopsy – 20 minutes
  • Intralesional scalp injections – 10 minutes
  • Micro-needling – 30 minutes
  • Platelet Rich Plasma – 1hour

How to prepare for your consultation with Dr. Khoza

  1. Take careful note of your symptoms. It is important to give Dr. Khoza an accurate description of what you have been experiencing. Has the hair been falling out gradually? Has it been only in certain patches, or has it been a constant and ongoing “loss” from all over the scalp?
  2. Think of any changes in your life that may coincide with the hair loss. Have you been taking a new medication, or have you stopped using a medication? Have you changed your level of physical activity? Have you gone through any major stresses, changed your diet, started or stopped taking any vitamins, or used a new hair or skin product, like shampoo?
  3. Be prepared for questions. Dr. Khoza will also want to know if hair loss runs in your family, and if so, at what age did your relatives experience hair loss for the first time?
  4. Dr. Khoza will examine your scalp during the consultation. Sebum, or oil, can sometimes play an important role in hair loss, so it may be advised to avoid washing your hair for a day or two prior to the appointment.
  5. Bring a list of medications used in the last two years.
  6. Bring your latest bloods if you have done any in the last six months.
  7. It always helps to bring all current hair and scalp products.
  8. Bring old photos up to 5 years prior if possible.
  9. Keep a positive outlook.

Improve the health of your scalp and hair with a comprehensive treatment plan designed for you. Contact Dr. Khoza and book your consult.