What should you know about follicular decalvans?

Folliculitis decalvans usually affects areas of the scalp with hair growth. Tender or itchy follicle-centred bumps, pustules, crusts and small areas of bleeding may occur. Several hairs can appear to emerge from one opening, a pattern called tufting. As inflammation continues, follicles may be destroyed and leave smooth areas where hair cannot regrow. The condition can resemble other causes of scalp itching, pustules or hair loss, so a dermatologist may examine the scalp closely and decide whether further testing is needed.

Arrange dermatology care early if you notice recurring scalp pustules with widening or smooth hair-loss areas. Use gentle shampoo, avoid picking crusts, and reduce tight hairstyles, scratching and friction. Treatment aims to calm inflammation and control follicle-associated microbes. Depending on the examination, a clinician may discuss oral antibiotics for acne or an intralesional steroid injection into selected inflamed areas. The plan may need review over time because activity can return.

Seek a prompt appointment for painful pustules that keep returning, crusting with spreading redness, bleeding lesions or new scarring hair loss. Get urgent medical help if scalp swelling progresses quickly, severe pain is accompanied by fever, or redness extends onto the face. Early assessment helps distinguish active inflammation from established scarring and guides the next step.

Ask whether the hair loss is scarring, how active the follicle inflammation appears, which treatment target is most relevant, and how you should monitor new pustules or changes in hair density.