Folliculitis decalvans: clinical and morphological characteristics (literature review)

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Folliculitis decalvans is a rare disease of primary cicatricial alopecias, about 11% of all alopecias of this group. Dermatosis was first described by the French dermatologist Charles-Eugène Quinquaud in 1888 and 1889. In recent decades, the number of publications devoted to the etiopathogenesis, clinical and histological characteristics, as well as approaches to the treatment of folliculitis decalvans has increased.

The article presents the results of data analysis on the databases Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, Global Health, CyberLeninka, RSCI.

The etiopathogenesis of the disease is still unknown. The role of seborrhea and skin colonization by Staphylococcus aureus, as well as impaired local immune response and the presence of a genetic predisposition, have previously been discussed. Folliculitis decalvans is now thought to be a result of persistent disruption of the skin barrier that predisposes to subepidermal invasion by opportunistic microorganisms, including Staphylococcus aureus. Clinical, dermatoscopic (trichoscopic) and histological characteristics of dermatosis are being specified. Its characteristic clinical features are a persistent progressive course, the formation of alopecia foci with a rich red edge, pustules and crusts along the periphery of the alopecia foci, polytrichia and the formation of a dense scar that rises above the surrounding skin. Dermatoscopic characteristics depend on the intensity of the inflammatory process. Specific trichoscopic signs of the disease include follicular pustules, yellow tubular desquamation, yellow crusts, perifollicular erythema, perifollicular hemorrhages, and fine tortuous vessels. Depending on the number of these signs, the degree of inflammation is determined. Histological features of the disease include a massive perifollicular infiltrate, the formation of gaps between the epithelium of the follicles and the surrounding stroma, and in the final stages of the process ― fibrous tracts, diffuse fibrosis in the dermis.

The treatment of folliculitis decalvans are antibacterial drugs, it is also possible to treat with courses of topical corticosteroids, antiseptic solutions.

We assume that the systematization of information about the etiopathogenesis and approaches to the diagnosis and treatment of folliculitis decalvans will improve the diagnosis among other primary cicatricial alopecia and the choice of the tactics of treating folliculitis decalvans.

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About the authors

Irina O. Smirnova

Saint-Petersburg State University; City Dermatovenerological Dispensary; Almazov National Medical Research Centre

ORCID iD: 0000-0001-8584-615X
SPIN-code: 5518-6453

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg; Saint Petersburg; Saint Petersburg

Olga M. Medetskaya

Saint-Petersburg State University; City Dermatovenerological Dispensary

Author for correspondence.
ORCID iD: 0000-0002-9077-2594
SPIN-code: 7735-2018
Russian Federation, Saint Petersburg; Saint Petersburg

Anna Y. Bessalova

North-Western State Medical University named after I.I. Mechnikov

ORCID iD: 0000-0003-1744-7610
SPIN-code: 9499-1671

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Natalia V. Shin

Saint-Petersburg State University

ORCID iD: 0000-0002-8138-1639
SPIN-code: 3343-8607

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg


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Supplementary files

Supplementary Files
1. Fig. 1. Patient K. Clinical manifestations of folliculitis decalvans. In the region of the crown there is a focus of hair loss with a dense, porcelain-white scar with the formation of pustules along the periphery, erosions with serous crusts and polytrichia.

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2. Fig. 2. Patient M. Clinical manifestations of folliculitis decalvans. In the region of the crown there is a focus of hair loss with the formation of an elongated and dense scar simulating scleroderma.

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3. Fig. 3. Patient K. Trichoscopic picture: а ― the focus of cicatricial hair loss along the periphery with pustules and massive serous crusts, perifollicular peeling with yellow scales, polytrichia, ×10; b ― on the periphery of the focus of cicatricial hair loss - polytrichia with serous-purulent crusts, ×10.

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4. Fig. 4. Patient M. Trichoscopic picture: а ― a focus of cicatricial hair loss with polytyrichia with more than 15 hairs, ×10; b ― the focus of cicatricial hair loss with polytrichia up to 12 hairs, ×10.

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