Trichoscopy of Folliculitis Decalvans

Key Trichoscopic Signs of Folliculitis Decalvans

Folliculitis decalvans (FD) is a scarring alopecia which causes permanent hair loss. Patients develop red, itchy scalps that often contains pimples. Bacteria such as Staphylococcus aureus can sometimes be isolated when swabs are taken from these pimples.

A number of “trichoscopic” or “dermatoscopic” signs are suggestive of folliculitis decalvans including some I have shown here: (1) perifollicular “tubular” scaling, (2) compound follicles containing 6 or more hairs, (3) linear fibrotic bands and the (4) red “strawberry ice cream” color.

(1) Perifollicular “tubular” scaling

Trichoscopy (Scalp Dermoscopy) of Folliculitis Decalvans, Image 1. tubular scaling. The scale rides up higher on the hair shaft in folliculitis decalvans than in lichen planopilaris.

(2) Compound Follicles (Containing 6 or more Hairs)

Trichoscopy (Scalp Dermoscopy) of Folliculitis Decalvans, Image 2. “Compound follicles” are follicles containing more than 6 hairs emerging from a single pore.

(3) Linear fibrotic bands

Trichoscopy (Scalp Dermoscopy) of Folliculitis Decalvans, Image 3. Linear Fibrotic bands indicate a pattern of scarring associated with the typical starburst scaling.

(4) Red “Strawberry ice cream” Color.

Trichoscopy (Scalp Dermoscopy) of Folliculitis Decalvans, Image 4. Strawberry Red Color.

Folliculitis decalvans (FD) vs Lichen planopilaris (LPP).

Folliculitis decalvans can resemble lichen planopilaris at first glance. However, it does have many differences. Compared to LPP, FD is more likely to have pustules, is more likely to bleed, is more likely to showing compound follicles or “tufting” and is more likely to have tubular scaling the climbs up the follicles (as in this image) and more likely to have these linear fibrotic bands too. Treatment for FD has been discussed in other posts but includes antibiotics, isotretinoin as well as other treatments.