Diagnostic Delay, Comorbid Hidradenitis Suppurativa, and the Prognostic Significance of Bacterial Cultures in Folliculitis Decalvans: A Cohort Study

This retrospective cohort study examined 192 patients with Folliculitis decalvans (FD) diagnosed between 2010 and 2020, revealing an average diagnostic delay of 22.2 months. The study found that comorbid conditions involving follicle occlusion were common, and 45.6% of cases had positive bacterial cultures, predominantly Staphylococcus aureus. Severe disease progression was linked to comorbid Hidradenitis suppurativa and positive bacterial cultures. Complete remission occurred in 50.7% of patients, with 32% achieving it within the first six months of treatment. Recurrences were frequent, and negative prognostic factors for remission included younger age and positive bacterial cultures. The study highlights the need for improved dermatologist training to reduce diagnostic delays and emphasizes the importance of screening for comorbid conditions and bacterial cultures in treatment planning.