What are the treatment options for folliculitis decalvans?

This condition affects scalp hair follicles and can cause tender or itchy bumps, pustules, crusting and clumps of hairs growing from one opening. Ongoing inflammation may damage follicles and leave smooth areas where hair cannot regrow. Treatment is therefore aimed at settling current activity and preserving unaffected follicles; it may not restore hair lost to scarring.

A dermatologist may examine the scalp closely and, when needed, sample material or a small area of skin to distinguish folliculitis decalvans from other causes of scalp pustules. Oral antimicrobial medicine may be selected when inflammation and follicle bacteria need control; a related option is [Oral Antibiotics For Acne](/treatments/medical-dermatology/oral-antibiotics-for-acne/). Steroid medicine injected into active plaques can reduce local inflammation; see [Steroid Injection Into The Skin](/treatments/injectables/intralesional-steroid-injection/). Do not squeeze pustules or share combs, hats or brushes. Use the cleanser and schedule prescribed for your scalp, and attend follow-up even if symptoms temporarily settle.

Arrange dermatology care promptly if pustules, crusting, pain or hair loss are spreading. Seek urgent medical help for rapidly increasing redness, marked swelling, fever, severe pain or feeling acutely unwell. New shiny or permanently smooth patches also deserve assessment because they can signal follicle damage.

Ask which findings show that the disease is active, whether testing is needed, how long the proposed medicine should be used, and how side effects will be monitored. Ask what scalp products to avoid and how treatment will change if new pustules or hair loss appear.