Activity-Based Therapeutic Algorithm for Folliculitis Decalvans: A Practical Tool for Effective Management

The study presents a therapeutic algorithm for managing folliculitis decalvans (FD), a common form of scarring alopecia. It emphasizes the importance of accurate diagnosis and management to prevent irreversible scarring and systemic complications. The algorithm is based on disease activity, assessed using the Investigator's Global Assessment score and the Trichoscopy Activity Scale. Management is divided into acute and mild inflammatory phases, with oral antibiotics and corticosteroids recommended for the acute phase, and oral isotretinoin for mild activity. The study highlights the lack of clinical trials for FD treatments and the off-label use of medications, while also cautioning against the use of antibiotics essential for systemic infections due to resistance risks. The algorithm includes additional systemic and topical therapies, offering a structured guideline for dermatologists and paving the way for future research on FD treatment strategies.