Management of Folliculitis Decalvans: The EADV Task Force on Hair Diseases Position Statement

April 2025 in “ Journal of the European Academy of Dermatology and Venereology ”

Anna Waśkiel‐Burnat, Michela Starace, Matilde Iorizzo, Alexander Katoulis, Zoé Apalla, Leila Asfour, Azael Freites‐Martínez, D. Ioannides, S. Morteza Seyed Jafari, Awatef Kelati, Francesca Pampaloni, Bianca Maria Piraccini, Adriana Rakowska, Andrea Sechi, Anita Takwale, Anastasia Therianou, Lidia Rudnicka

folliculitis decalvans scarring alopecia oral antibiotics oral glucocorticosteroids oral isotretinoin photodynamic therapy biologics JAK inhibitors oral dapsone hydroxychloroquine cyclosporine topical corticosteroids intralesional corticosteroids surgical excision laser therapy hair transplantation Accutane Plaquenil Neoral

TLDR Control inflammation and prevent further hair loss in folliculitis decalvans using medications and therapies.

The management of folliculitis decalvans (FD), a chronic and relapsing form of scarring alopecia, involves a range of topical and systemic treatments aimed at controlling inflammation and preventing further hair loss. While no specific drug is approved for FD, various off-label treatments are used, including topical glucocorticosteroids, antibiotics, and systemic options like isotretinoin and hydroxychloroquine. Photodynamic therapy and biologics such as adalimumab have shown promise in refractory cases. The EADV Task Force recommends individualized treatment plans, often requiring combinations of therapies and long-term management due to the relapsing nature of FD. Diagnosis is based on clinical and trichoscopic findings, with scalp biopsy for confirmation.

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research Carbon-Dioxide Laser-Associated PDT Treatment of Folliculitis Decalvans

1 citations , March 2024 in “International Journal of Dermatology”

CO2 laser-associated PDT effectively treated therapy-resistant folliculitis decalvans.

Clinical Characterization and Treatment Response of Folliculitis Decalvans Lichen Planopilaris Phenotypic Spectrum: A Retrospective Series of 31 Patients

research Clinical Characterization and Treatment Response of Folliculitis Decalvans Lichen Planopilaris Phenotypic Spectrum: A Retrospective Series of 31 Patients

February 2024 in “Acta dermato-venereologica”

This type of hair loss is probably often missed and treatments reducing inflammation might work well.

research Guidelines of Care for the Management of Acne Vulgaris

5 citations , January 2024 in “Journal of the American Academy of Dermatology”

Use benzoyl peroxide, retinoids, antibiotics, and isotretinoin for acne, and combine treatments for better results.

research European Expert Consensus Statement on the Systemic Treatment of Alopecia Areata

4 citations , January 2024 in “JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology”

Baricitinib and ritlecitinib are recommended for severe alopecia areata, with other treatments available off-label.

$Refractory Folliculitis Decalvans Treatment Success with a Novel Surgical Excision Approach Using Guarded High-Tension Sutures$

research Refractory Folliculitis Decalvans Treatment Success with a Novel Surgical Excision Approach Using Guarded High-Tension Sutures

September 2023 in “Clinical, cosmetic and investigational dermatology”

A new surgical method using special sutures significantly reduced wound size and prevented disease return in patients with a scarring scalp condition.

Alopecias: Practical Tips for the Management of Biopsies and Main Diagnostic Clues for General Pathologists and Dermatopathologists

research Alopecias: Practical Tips for the Management of Biopsies and Main Diagnostic Clues for General Pathologists and Dermatopathologists

July 2023 in “Journal of Clinical Medicine”

The document concludes that understanding hair follicle histology and the hair cycle is crucial for diagnosing alopecia.

research Botulinum Toxin A as an Alternative Treatment for Folliculitis Decalvans

March 2023 in “JAAD case reports”

Botulinum toxin A may be an effective alternative treatment for the scalp disorder folliculitis decalvans.

research Refractory Folliculitis Decalvans Treated With Adalimumab: A Case Series of 23 Patients

24 citations , March 2022 in “Journal of the American Academy of Dermatology”

Adalimumab improved folliculitis decalvans in most patients.

research Treatment of Diseases Associated with Cicatricial Alopecia

January 2022 in “Przegla̧d dermatologiczny”

The document concludes that there are various treatments for diseases linked to scarring hair loss, especially for primary scarring alopecia.

$The Role of Platelet-Rich Plasma Therapy in Refractory Folliculitis Decalvans$

research The Role of Platelet-Rich Plasma Therapy in Refractory Folliculitis Decalvans

5 citations , June 2021 in “JAAD Case Reports”

Platelet-rich plasma therapy may help treat folliculitis decalvans but benefits might not last without ongoing treatment.

research Folliculitis Decalvans Responsive to Tofacitinib: A Case Series

8 citations , July 2020 in “Dermatologic Therapy”

Tofacitinib may effectively treat folliculitis decalvans.

research Successful Treatment of Refractory Folliculitis Decalvans with Secukinumab

10 citations , October 2019 in “Australasian Journal of Dermatology”

Secukinumab effectively treated a difficult case of folliculitis decalvans.

research Low-Dose Naltrexone: A Novel Adjunctive Treatment in Symptomatic Alopecias?

4 citations , January 2019 in “Dermatology Online Journal”

Low-dose naltrexone might be a cheap and effective additional treatment for hair loss with scalp discomfort due to its anti-inflammatory effects and few side effects.

research Frequency of the Types of Alopecia at Twenty-Two Specialist Hair Clinics: A Multicenter Study

56 citations , January 2019 in “Skin appendage disorders”

The most common hair loss type at specialist clinics is androgenetic alopecia, especially in younger men, followed by alopecia areata and telogen effluvium, with differences seen across regions.

research A Systematic Review of the Outcome of Hair Transplantation in Primary Scarring Alopecia

27 citations , September 2018 in “Skin appendage disorders”

Hair transplantation may work for some types of scarring alopecia, but results vary and more research is needed.

research Updates in Therapeutics for Folliculitis Decalvans: A Systematic Review with Evidence-Based Analysis

40 citations , August 2018 in “Journal of the American Academy of Dermatology”

Clindamycin and rifampicin are the most effective treatments for folliculitis decalvans, but more research is needed.

Folliculitis Decalvans: Effectiveness of Therapies and Prognostic Factors in a Multicenter Series of 60 Patients with Long-Term Follow-Up

research Folliculitis Decalvans: Effectiveness of Therapies and Prognostic Factors in a Multicenter Series of 60 Patients with Long-Term Follow-Up

41 citations , June 2018 in “Journal of The American Academy of Dermatology”

Some treatments for folliculitis decalvans work well, with tetracyclines and a mix of rifampicin and clindamycin being most effective.

research Cicatricial Alopecia: Overview and Treatment Recommendations

23 citations , April 2018 in “Journal der Deutschen Dermatologischen Gesellschaft”

Permanent hair loss from cicatricial alopecia is treated by reducing inflammation and managing symptoms, but regrowth in scarred areas is unlikely.

research Isotretinoin Treatment for Folliculitis Decalvans: A Retrospective Case-Series Study

23 citations , January 2018 in “International Journal of Dermatology”

Oral isotretinoin, especially at higher doses for at least 3 months, is effective for treating folliculitis decalvans.

research Treatment of Permanent Chemotherapy-Induced Alopecia with Low Dose Oral Minoxidil

36 citations , May 2015 in “Australasian Journal of Dermatology”

Low dose oral minoxidil helps regrow hair in permanent chemotherapy-induced alopecia.

research Oral Isotretinoin as the Most Effective Treatment in Folliculitis Decalvans: A Retrospective Comparison of Different Treatment Regimens in 28 Patients

37 citations , February 2015 in “Journal of the European Academy of Dermatology and Venereology”

Oral isotretinoin is the most effective treatment for folliculitis decalvans.

research Folliculitis Decalvans: A Multicenter Review of 82 Patients

68 citations , February 2015 in “Journal of the European Academy of Dermatology and Venereology”

Early onset and pustules indicate severe hair follicle inflammation, and while antibiotics help, the condition often worsens after treatment stops.

research Retrospective Review of Folliculitis Decalvans in 23 Patients with Course and Treatment Analysis of Long-Standing Cases

43 citations , January 2015 in “Journal of Cutaneous Medicine and Surgery”

Most patients improved with oral antibiotics, but some needed long-term treatment or had minimal response.

research Long-Term Remission of Folliculitis Decalvans After Treatment with the Long-Pulsed Nd:YAG Laser

27 citations , July 2013 in “Journal of dermatological treatment”

Laser therapy may effectively treat persistent scalp inflammation.

research Effective Treatment of Folliculitis Decalvans Using Selected Antimicrobial Agents

33 citations , January 2010 in “International journal of trichology”

Antimicrobial therapy can help manage Folliculitis Decalvans.

research Intralesional Steroids for Alopecia Areata

36 citations , January 2010 in “International Journal of Trichology”

Intralesional steroids can help regrow hair in some alopecia areata patients but have side effects.

research Folliculitis Decalvans: A Rare Inflammatory Scalp Disorder

112 citations , July 2008 in “Dermatologic Therapy”

Folliculitis decalvans is a rare scalp condition causing scarring hair loss, treated with long-term antibiotics and other medications, but it often comes back and is hard to manage.

research Folliculitis Decalvans Including Tufted Folliculitis: Clinical, Histological, and Therapeutic Findings

226 citations , February 1999 in “British Journal of Dermatology”

Folliculitis decalvans and tufted folliculitis are related, and a new treatment with rifampicin and clindamycin is effective.