Folliculitis Decalvans Developing 20 Years After Hair Restoration Surgery in Punch Grafts: Case Report

In 2009, a 43-year-old male developed Folliculitis Decalvans (FD), a rare inflammatory scalp disorder, 20 years after he had hair restoration surgery. The FD was only present in the area where punch grafts were used during the surgery. The patient was treated with a combination of oral minocycline, topical hydrocortisone acetate and fucidic acid cream, triclosan 0.5% cleanser, and initial fluocinolone 0.01% in peanut oil at bedtime. Reducing the dose of oral minocycline led to mild flare-ups, suggesting a need for long-term antibiotic treatment. The patient wanted more hair restoration surgery, but it was not recommended due to the risk of FD reactivation. The cause of FD is not fully known, but Staphylococcus aureus and an abnormality in the host defense mechanism seem to be important factors. More research is needed to understand FD and find better and safer treatments.