Folliculitis decalvans: Effectiveness of therapies and prognostic factors in a multicenter series of 60 patients with long-term follow-up

J Am Acad Dermatol. 2018 Nov;79(5):878-883. doi: 10.1016/j.jaad.2018.05.1240. Epub 2018 Jun 2.


Background: Folliculitis decalvans (FD) is a rare neutrophilic cicatricial alopecia that poses a therapeutic challenge.

Objectives: To describe the therapeutic response in a large number of cases of FD with long-term follow-up and analyze potential prognostic factors associated with severity of form and with a better therapeutic response.

Methods: This multicenter prospective study included patients with FD who had a minimum of 5 years of follow-up. Severity was assessed by the maximum diameter of the cicatricial area. Therapeutic response was evaluated according to stabilization of the size of the cicatricial areas and the improvement in clinical symptoms.

Results: A total of 60 patients (37 men [61.7%] and 23 women [38.3%]) with a mean age of 40 years were included. Earlier age of onset (P = .01) was statistically associated with severity of form. Treatment with rifampicin and clindamycin, tetracyclines, and intralesional steroids was the most effective. No statistically significant prognostic factors predicting a better therapeutic response were found.

Limitations: Because FD is a rare disease, the main limitation was the sample size.

Conclusions: An earlier age of onset was associated with the severe form of the disease. The proposed specific therapeutic protocol can be a very useful tool in clinical dermatologic practice.

Keywords: clindamycin; follicutis decalvans; pustules; quality of life; rifampicin; scarring alopecia; tetracyclines; tufted hairs.

Publication types

  • Multicenter Study

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Alopecia / drug therapy
  • Alopecia / etiology
  • Alopecia / pathology*
  • Anti-Bacterial Agents / therapeutic use
  • Cicatrix / drug therapy
  • Cicatrix / pathology
  • Cohort Studies
  • Combined Modality Therapy
  • Female
  • Folliculitis / complications
  • Folliculitis / drug therapy*
  • Folliculitis / pathology*
  • Follow-Up Studies
  • Humans
  • Isotretinoin / therapeutic use
  • Male
  • Minoxidil / therapeutic use
  • Multivariate Analysis
  • Photochemotherapy / methods
  • Retrospective Studies
  • Risk Assessment
  • Scalp Dermatoses / complications
  • Scalp Dermatoses / drug therapy*
  • Scalp Dermatoses / pathology*
  • Spain
  • Time Factors
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents
  • Minoxidil
  • Isotretinoin