Management of Folliculitis Decalvans: A Systematic Review

October 2025 in “ Australasian Journal of Dermatology ”

Emily Sideris, Danica Xie, Johan du Plessis, Sally de Zwaan

Folliculitis Decalvans Tufted Hair Folliculitis scarring alopecia systemic antibiotics topical agents local agents systemic agents biologic agents laser therapy

TLDR Combination therapies may be more effective for treating Folliculitis Decalvans than antibiotics alone.

This systematic review examines the management of Folliculitis Decalvans (FD) and Tufted Hair Folliculitis (THF), conditions that cause scarring alopecia and significantly affect patients' quality of life. The review analyzed 113 articles involving 728 patients and 2041 treatment episodes across 246 different treatments. The study found that systemic antibiotic monotherapy may not be as effective as previously thought. Instead, combination therapies involving systemic antibiotics, topical, local, and other systemic agents, including biologic agents and laser therapy, may offer better outcomes and longer durations of effect. Despite the low to very low GRADE level of evidence, these findings suggest a shift towards more comprehensive treatment strategies for FD/THF.

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