Folliculitis decalvans: clinical and morphological characteristics (literature review)

Abstract

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.

Keywords

folliculitis decalvans / trichoscopy / review / histology / treatment

References

[1] Quinquaud E. Folliculite epilante et destructive des regions values. Bull Mem Soc Hop Paris. 1888;5:395–398.

[2] Quinquaud С.E. Folliculite epilante et destructive des regions values // Bull Mem Soc Hop Paris. 1888. Vol. 5. Р. 395–398.

[3] Quinquaud E. Folliculite épilante décalvante. Ann Dermat Syph. 1889;10:99–101.

[4] Quinquaud С.E. Folliculite épilante décalvante // Ann Dermat Syph. 1889. Vol. 10. Р. 99–101.

[5] Brocq L, Lenglet E, Ayrignac J. Recherches sur l’alopecie atrophiante, variete pseudo-pelade. Ann Dermatol Syphil (France). 1905;6:1–32.

[6] Brocq L., Lenglet E., Ayrignac J. Recherches sur l’alopecie atrophiante, variete pseudo-pelade // Ann Dermatol Syphil (France). 1905. Vol. 6. Р. 1–32.

[7] McCarthy L. Diagnosis and treatment of diseases of the hair. Southern Med J. 1940;33(10):1114. doi: 10.1097/00007611-194010000-00032

[8] McCarthy L. Diagnosis and treatment of diseases of the hair // Southern Med J. 1940. Vol. 33, N 10. Р. 1114. doi: 10.1097/00007611-194010000-00032

[9] Smith N, Sanderson K. Tufted folliculitis of the scalp. J R Soc Med. 1978;71(8):606–608. doi: 10.1177/014107687807100813

[10] Smith N., Sanderson K. Tufted folliculitis of the scalp // J R Soc Med. 1978. Vol. 71, N 8. Р. 606–608. doi: 10.1177/014107687807100813

[11] Vañó-Galván S, Saceda-Corralo D, Blume-Peytavi U, et al. Frequency of the types of alopecia at twenty-two specialist hair clinics: a multicenter study. Skin Appendage Disord. 2019;5(5):309–315. doi: 10.1159/000496708

[12] Vañó-Galván S., Saceda-Corralo D., Blume-Peytavi U., et al. Frequency of the types of alopecia at twenty-two specialist hair clinics: a multicenter study // Skin Appendage Disord. 2019. Vol. 5, N 5. Р. 309–315. doi: 10.1159/000496708

[13] Miguel-Gomez L, Vano-Galvan S, Perez-Garcia B, et al. Treatment of folliculitis decalvans with photodynamic therapy: results in 10 patients. J Am Acad Dermatol. 2015;72(6):1085–1087. doi: 10.1016/j.jaad.2015.02.1120

[14] Miguel-Gomez L., Vano-Galvan S., Perez-Garcia B., et al. Treatment of folliculitis decalvans with photodynamic therapy: results in 10 patients // J Am Acad Dermatol. 2015. Vol. 72, N 6. Р. 1085–1087. doi: 10.1016/j.jaad.2015.02.1120

[15] Powell J, Dawber R, Gatter K. Folliculitis decalvans including tufted folliculitis: clinical, histological and therapeutic findings. Brit J Dermatol. 1999;140(2):328–333. doi: 10.1046/j.1365-2133.1999.02675.x

[16] Powell J., Dawber R., Gatter K. Folliculitis decalvans including tufted folliculitis: clinical, histological and therapeutic findings // Brit J Dermatol. 1999. Vol. 140, N 2. Р. 328–333. doi: 10.1046/j.1365-2133.1999.02675.x

[17] Sperling L, Whiting D, Solomon A. Folliculitis decalvans and tufted folliculitis are specific infective diseases that may lead to scarring, but are not a subset of central centrifugal scarring alopecia. Arch Dermatol. 2001;137(3):373–374.

[18] Sperling L., Whiting D., Solomon A. Folliculitis decalvans and tufted folliculitis are specific infective diseases that may lead to scarring, but are not a subset of central centrifugal scarring alopecia // Arch Dermatol. 2001. Vol. 137, N 3. Р. 373–374.

[19] Eyraud A, Milpied B, Thiolat D, et al. Inflammasome activation characterizes lesional skin of folliculitis decalvans. Acta Dermato Venereologica. 2018;98(6):570–575. doi: 10.2340/00015555-2924

[20] Eyraud A., Milpied B., Thiolat D., et al. Inflammasome activation characterizes lesional skin of folliculitis decalvans // Acta Dermato Venereologica. 2018. Vol. 98, N 6. Р. 570–575. doi: 10.2340/00015555-2924

[21] Chiarini C, Torchia D, Bianchi B, et al. Immunopathogenesis of folliculitis decalvans. Am J Clin Pathol. 2008;130(4):526–534. doi: 10.1309/ng60y7v0wnufh4la

[22] Chiarini C., Torchia D., Bianchi B., et al. Immunopathogenesis of folliculitis decalvans // Am J Clin Pathol. 2008. Vol. 130, N 4. Р. 526–534. doi: 10.1309/ng60y7v0wnufh4la

[23] Matard B, Meylheuc T, Briandet R, et al. First evidence of bacterial biofilms in the anaerobe part of scalp hair follicles: a pilot comparative study in folliculitis decalvans. J Eur Academy Dermatol Venereol. 2012;27(7):853–860. doi: 10.1111/j.1468-3083.2012.04591.x

[24] Matard B., Meylheuc T., Briandet R., et al. First evidence of bacterial biofilms in the anaerobe part of scalp hair follicles: a pilot comparative study in folliculitis decalvans // J Eur Academy Dermatol Venereol. 2012. Vol. 27, N 7. Р. 853–860. doi: 10.1111/j.1468-3083.2012.04591.x

[25] Matard B, Donay J, Resche-Rigon M, et al. Folliculitis decalvans is characterized by a persistent, abnormal subepidermal microbiota. Exp Dermatol. 2019;29(3):295–298. doi: 10.1111/exd.13916

[26] Matard B., Donay J., Resche-Rigon M., et al. Folliculitis decalvans is characterized by a persistent, abnormal subepidermal microbiota // Exp Dermatol. 2019. Vol. 29, N 3. Р. 295–298. doi: 10.1111/exd.13916

[27] Miguel-Gómez L, Rodrigues-Barata A, Molina-Ruiz A, et al. 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;79(5):878–883. doi: 10.1016/j.jaad.2018.05.1240

[28] Miguel-Gómez L., Rodrigues-Barata A., Molina-Ruiz A., et al. 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. Vol. 79, N 5. Р. 878–883. doi: 10.1016/j.jaad.2018.05.1240

[29] Vañó-Galván S, Molina-Ruiz A, Fernández-Crehuet P, et al. Folliculitis decalvans: a multicentre review of 82 patients. J Eur Academy Dermatol Venereol. 2015;29(9):1750–1757. doi: 10.1111/jdv.12993

[30] Vañó-Galván S., Molina-Ruiz A., Fernández-Crehuet P., et al. Folliculitis decalvans: a multicentre review of 82 patients // J Eur Academy Dermatol Venereol. 2015. Vol. 29, N 9. Р. 1750–1757. doi: 10.1111/jdv.12993

[31] Shitara A, Igareshi R, Morohashi M. Folliculitis decalvans and cellular immunity ― two brothers with oral candidosis. Jap J Dermatol. 1974;28:133–140.

[32] Shitara A., Igareshi R., Morohashi M. Folliculitis decalvans and cellular immunity ― two brothers with oral candidosis // Jap J Dermatol. 1974. Vol. 28. Р. 133–140.

[33] Frazer N, Grant P. Folliculitis decalvans with hypocomplementamia. Br J Dermatol. 1982;107:88.

[34] Frazer N., Grant P. Folliculitis decalvans with hypocomplementamia // Br J Dermatol. 1982. Vol. 107. Р. 88.

[35] Fernandes J, Correia T, Azevedo F, Mesquita-Guimarães J. Tufted hair folliculitis after scalp injury. Cutis. 2001;67(3):243–248.

[36] Fernandes J., Correia T., Azevedo F., Mesquita-Guimarães J. Tufted hair folliculitis after scalp injury // Cutis. 2001. Vol. 67, N 3. Р. 243–248.

[37] Otberg N, Wu W, Kang H, et al. Folliculitis decalvans developing 20 years after hair restoration surgery in punch grafts: case report. Dermatologic Sur. 2009;35(11):1852–1856. doi: 10.1111/j.1524-4725.2009.01305.x

[38] Otberg N., Wu W., Kang H., et al. Folliculitis decalvans developing 20 years after hair restoration surgery in punch grafts: case report // Dermatologic Sur. 2009. Vol. 35, N 11. Р. 1852–1856. doi: 10.1111/j.1524-4725.2009.01305.x

[39] Trüeb R, Tsambaos D, Spycher M, et al. Scarring folliculitis in the ectrodactyly-ectodermal dysplasia-clefting syndrome. Dermatol. 1997;194(2):191–194. doi: 10.1159/000246097

[40] Trüeb R., Tsambaos D., Spycher M., et al. Scarring folliculitis in the ectrodactyly-ectodermal dysplasia-clefting syndrome // Dermatol. 1997. Vol. 194, N 2. Р. 191–194. doi: 10.1159/000246097

[41] Tan E, Martinka M, Ball N, Shapiro J. Primary cicatricial alopecias: clinicopathology of 112 cases. J Am Acad Dermatol. 2004;50(1):25–32. doi: 10.1016/j.jaad.2003.04.001

[42] Tan E., Martinka M., Ball N., Shapiro J. Primary cicatricial alopecias: clinicopathology of 112 cases // J Am Acad Dermatol. 2004. Vol. 50, N 1. Р. 25–32. doi: 10.1016/j.jaad.2003.04.001

[43] Wolff H, Fischer T, Blume-Peytavi U. The Diagnosis and treatment of hair and scalp diseases. Deutsches Ärzteblatt Int. 2016;113(21):337–386. doi: 10.3238/arztebl.2016.0377

[44] Wolff H., Fischer T., Blume-Peytavi U. The diagnosis and treatment of hair and scalp diseases // Deutsches Ärzteblatt Int. 2016. Vol. 113, N 21. Р. 337–386. doi: 10.3238/arztebl.2016.0377

[45] Rezende H, Dias M, Kempf W, Treüb R. Linear circumscribed scleroderma-like folliculitis decalvans: yet another face of a protean condition. Int J Trichology. 2018;10(4):175–179. doi: 10.4103/ijt.ijt_9_18

[46] Rezende H., Dias M., Kempf W., Treüb R. Linear circumscribed scleroderma-like folliculitis decalvans: yet another face of a protean condition // Int J Trichology. 2018. Vol. 10, N 4. Р. 175–179. doi: 10.4103/ijt.ijt_9_18

[47] Mathur M, Acharya P. Trichoscopy of primary cicatricial alopecias: an updated review. J Eur Academy Dermatol Venereol. 2019;34(3):473–484. doi: 10.1111/jdv.15974

[48] Mathur M., Acharya P. Trichoscopy of primary cicatricial alopecias: an updated review // J Eur Academy Dermatol Venereol. 2019. Vol. 34, N 3. Р. 473–484. doi: 10.1111/jdv.15974

[49] Fernandez-Crehuet P, Vaño-Galván S, Molina-Ruiz A, et al. Trichoscopic features of folliculitis decalvans: Results in 58 Patients. Int J Trichology. 2017;9(3):140–141. doi: 10.4103/ijt.ijt_85_16

[50] Fernandez-Crehuet P., Vaño-Galván S., Molina-Ruiz A., et al. Trichoscopic features of folliculitis decalvans: results in 58 Patients // Int J Trichology. 2017. Vol. 9, N 3. Р. 140–141. doi: 10.4103/ijt.ijt_85_16

[51] Yang A, Hannaford R, Kossard S. Folliculitis decalvans-like pustular plaques on the limbs sparing the scalp. Aus J Dermatol. 2019;61(1):54–56. doi: 10.1111/ajd.13178

[52] Yang A., Hannaford R., Kossard S. Folliculitis decalvans-like pustular plaques on the limbs sparing the scalp // Aus J Dermatol. 2019. Vol. 61, N 1. Р. 54–56. doi: 10.1111/ajd.13178

[53] Forman L. Folliculitis Decalvans (de Quinquad). Proc R Soc Med. 1943;36(6):295. doi: 10.1177/003591574303600623

[54] Forman L. Folliculitis Decalvans (de Quinquad) // Proc R Soc Med. 1943. Vol. 36, N 6. Р. 295. doi: 10.1177/003591574303600623

[55] Karakuzu A, Erdem T, Aktas A, et al. A case of folliculitis decalvans involving the beard, face and nape. J Dermatol. 2001;28(6):329–331. doi: 10.1111/j.1346-8138.2001.tb00143.x

[56] Karakuzu A., Erdem T., Aktas A., et al. A case of folliculitis decalvans involving the beard, face and nape // J Dermatol. 2001. Vol. 28, N 6. Р. 329–331. doi: 10.1111/j.1346-8138.2001.tb00143.x

[57] Offidani A, Cellini A, Giangiacomi M, Bossi G. Quinquad’s folliculitis decalvans and tufted hair. Ann Dermatol Venereol. 1994;121(4):319–321.

[58] Offidani A., Cellini A., Giangiacomi M., Bossi G. Quinquad’s folliculitis decalvans and tufted hair // Ann Dermatol Venereol. 1994. Vol. 121, N 4. Р. 319–321.

[59] Senatore S, Maglie R, Maio V, et al. Folliculitis decalvans with exclusive beard involvement. Ind J Dermatol Venereol Leprol. 2021;83(4):569–571. doi: 10.25259/ijdvl_694_20

[60] Senatore S., Maglie R., Maio V., et al. Folliculitis decalvans with exclusive beard involvement // Ind J Dermatol Venereol Leprol. 2021. Vol. 83, N 4. Р. 569–571. doi: 10.25259/ijdvl_694_20

[61] Wheeland R, Thurmond R, Gilmore W, Blackstock R. Chronic blepharitis and pyoderma of the scalp: an immune deficiency state in a father and son with hypercupremia and decreased intracellular killing. Pediatr Dermatol. 1983;1(2):134–142. doi: 10.1111/j.1525-1470.1983.tb01104.x

[62] Wheeland R., Thurmond R., Gilmore W., Blackstock R. Chronic blepharitis and pyoderma of the scalp: an immune deficiency state in a father and son with hypercupremia and decreased intracellular killing // Pediatr Dermatol. 1983. Vol. 1, N 2. Р. 134–142. doi: 10.1111/j.1525-1470.1983.tb01104.x

[63] Janjua S, Iftikhar N, Pastar Z, Hosler G. Keratosis follicularis spinulosa decalvans associated with acne keloidalis nuchae and tufted hair folliculitis. Am J Clin Dermatol. 2008;9(2):137–140. doi: 10.2165/00128071-200809020-00009

[64] Janjua S., Iftikhar N., Pastar Z., Hosler G. Keratosis follicularis spinulosa decalvans associated with acne keloidalis nuchae and tufted hair folliculitis // Am J Clin Dermatol. 2008. Vol. 9, N 2. Р. 137–140. doi: 10.2165/00128071-200809020-00009

[65] Luz Ramos M, Muñoz-Pérez M, Pons A, et al. Acne keloidalis nuchae and tufted hair folliculitis. Dermatology. 1997;194(1):71–73. doi: 10.1159/000246063

[66] Luz Ramos M., Muñoz-Pérez M., Pons A., et al. Acne keloidalis nuchae and tufted hair folliculitis // Dermatology. 1997. Vol. 194, N 1. Р. 71–73. doi: 10.1159/000246063

[67] Stefanato C. Histopathology of alopecia: a clinicopathological approach to diagnosis. Histopathology. 2010;56(1):24–38. doi: 10.1111/j.1365-2559.2009.03439.x

[68] Stefanato C. Histopathology of alopecia: a clinicopathological approach to diagnosis // Histopathology. 2010. Vol. 56, N 1. Р. 24–38. doi: 10.1111/j.1365-2559.2009.03439.x

[69] Uchiyama M, Harada K, Tobita R, et al. Histopathologic and dermoscopic features of 42 cases of folliculitis decalvans: a case series. J Am Acad Dermatol. 2021;85(5):1185–1193. doi: 10.1016/j.jaad.2020.03.092

[70] Uchiyama M., Harada K., Tobita R., et al. Histopathologic and dermoscopic features of 42 cases of folliculitis decalvans: a case series // J Am Acad Dermatol. 2021. Vol. 85, N 5. Р. 1185–1193. doi: 10.1016/j.jaad.2020.03.092

[71] Pincus L, Price V, McCalmont T. The amount counts: distinguishing neutrophil-mediated and lymphocyte-mediated cicatricial alopecia by compound follicles. J Cutan Pathol. 2010;38(1):2–4. doi: 10.1111/j.1600-0560.2010.01645_2.x

[72] Pincus L., Price V., McCalmont T. The amount counts: distinguishing neutrophil-mediated and lymphocyte-mediated cicatricial alopecia by compound follicles // J Cutan Pathol. 2010. Vol. 38, N 1. Р. 2–4. doi: 10.1111/j.1600-0560.2010.01645_2.x

[73] Egger A, Stojadinovic O, Miteva M. Folliculitis decalvans and lichen planopilaris phenotypic spectrum ― a series of 7 new cases with focus on histopathology. Am J Dermatopathol. 2020;42(3):173–177. doi: 10.1097/dad.0000000000001595

[74] Egger A., Stojadinovic O., Miteva M. Folliculitis decalvans and lichen planopilaris phenotypic spectrum ― a series of 7 new cases with focus on histopathology // Am J Dermatopathol. 2020. Vol. 42, N 3. Р. 173–177. doi: 10.1097/dad.0000000000001595

[75] Rakowska A, Slowinska M, Kowalska-Oledzka E, et al. Trichoscopy of cicatricial alopecia. J Drugs Dermatol. 2012;11(6):753–758.

[76] Rakowska A., Slowinska M., Kowalska-Oledzka E., et al. Trichoscopy of cicatricial alopecia // J Drugs Dermatol. 2012. Vol. 11, N 6. Р. 753–758.

[77] Sharma V, Chiramel M, Khandpur S, Sreenivas V. Relevance of trichoscopy in the differential diagnosis of alopecia: a cross-sectional study from North India. Ind J Dermatol Venereol Leprol. 2016;82(6):651–658. doi: 10.4103/0378-6323.183636

[78] Sharma V., Chiramel M., Khandpur S., Sreenivas V. Relevance of trichoscopy in the differential diagnosis of alopecia: a cross-sectional study from North India // Ind J Dermatol Venereol Leprol. 2016. Vol. 82, N 6. Р. 651–658. doi: 10.4103/0378-6323.183636

[79] Saceda-Corralo D, Moreno-Arrones O, Rodrigues-Barata R, et al. Trichoscopy activity scale for folliculitis decalvans. J Eur Acad Dermatol Venereol. 2019;34(2):e55–e57. doi: 10.1111/jdv.15900

[80] Saceda-Corralo D., Moreno-Arrones O., Rodrigues-Barata R., et al. Trichoscopy activity scale for folliculitis decalvans // J Eur Acad Dermatol Venereol. 2019. Vol. 34, N 2. Р. e55–e57. doi: 10.1111/jdv.15900

[81] Miteva M, Tosti A. Dermoscopy guided scalp biopsy in cicatricial alopecia. J Eur Acad Dermatol Venereol. 2012;27(10):1299–1303. doi: 10.1111/j.1468-3083.2012.04530.x

[82] Miteva M., Tosti A. Dermoscopy guided scalp biopsy in cicatricial alopecia // J Eur Acad Dermatol Venereol. 2012. Vol. 27, N 10. Р. 1299–1303. doi: 10.1111/j.1468-3083.2012.04530.x

[83] Tietze J, Heppt M, von Preußen A, et al. Oral isotretinoin as the most effective treatment in folliculitis decalvans: a retrospective comparison of different treatment regimens in 28 patients. J Eur Acad Dermatol Venereol. 2015;29(9):1816–1821. doi: 10.1111/jdv.13052

[84] Tietze J., Heppt M., von Preußen A., et al. Oral isotretinoin as the most effective treatment in folliculitis decalvans: a retrospective comparison of different treatment regimens in 28 patients // J Eur Acad Dermatol Venereol. 2015. Vol. 29, N 9. Р. 1816–1821. doi: 10.1111/jdv.13052

[85] Bunagan M, Banka N, Shapiro J. Retrospective review of folliculitis decalvans in 23 patients with course and treatment analysis of long-standing cases. J Cutan Med Surg. 2015;19(1):45–49. doi: 10.2310/7750.2014.13218

[86] Bunagan M., Banka N., Shapiro J. Retrospective review of folliculitis decalvans in 23 patients with course and treatment analysis of long-standing cases // J Cutan Med Surg. 2015. Vol. 19, N 1. Р. 45–49. doi: 10.2310/7750.2014.13218

[87] Sillani C, Bin Z, Ying Z, et al. Effective treatment of folliculitis decalvans using selected antimicrobial agents. Int J Trichology. 2010;2(1):20. doi: 10.4103/0974-7753.66908

[88] Sillani C., Bin Z., Ying Z., et al. Effective treatment of folliculitis decalvans using selected antimicrobial agents // Int J Trichology. 2010. Vol. 2, N 1. Р. 20. doi: 10.4103/0974-7753.66908

[89] Aksoy B, Hapa A, Mutlu E. Isotretinoin treatment for folliculitis decalvans: a retrospective case-series study. Int J Dermatol. 2018;57(2):250–253. doi: 10.1111/ijd.13874

[90] Aksoy B., Hapa A., Mutlu E. Isotretinoin treatment for folliculitis decalvans: a retrospective case-series study // Int J Dermatol. 2018. Vol. 57, N 2. Р. 250–253. doi: 10.1111/ijd.13874

[91] Yang L, Chen J, Tong X, et al. Photodynamic therapy should be considered for the treatment of folliculitis decalvans. Photodiagnosis Photodynamic Therapy. 2021;35:102356. doi: 10.1016/j.pdpdt.2021.102356

[92] Yang L., Chen J., Tong X., et al. Photodynamic therapy should be considered for the treatment of folliculitis decalvans // Photodiagnosis Photodynamic Therapy. 2021. Vol. 35. Р. 102356. doi: 10.1016/j.pdpdt.2021.102356

RIGHTS & PERMISSIONS

Eco-Vector