What is the first treatment for folliculitis decalvans?

Folliculitis decalvans is a chronic inflammatory scalp disorder that can cause pustules, crusting, soreness, and groups of hairs emerging from one opening. Persistent inflammation may injure follicles and leave areas of scarring hair loss, so treatment aims to calm activity and protect follicles that remain active.

An intralesional steroid injection delivers anti-inflammatory medicine into selected scalp lesions. Oral antibiotics may be used when active pustules or tenderness suggest an antimicrobial approach is needed. The choice depends on the scalp examination, extent of disease, previous treatment, and medical history.

Book a dermatology review if you notice recurring scalp pustules, crusts, painful spots, tufts of hairs, or expanding smooth areas. Avoid picking crusts and avoid close shaving over active lesions. Use gentle scalp products and do not share combs, brushes, hats, or pillowcases while the scalp is inflamed.

Keep a simple record of flare timing, tenderness, drainage, and hair changes. If oral antibiotics are prescribed, take them only as directed and report troublesome reactions. Ask whether an intralesional steroid injection is suitable for a particular inflamed patch rather than treating the scalp without an examination.

Seek prompt care if scalp pain, swelling, pus, crusting, or redness is rapidly worsening, or if you develop fever or feel unwell. New smooth shiny hairless areas, spreading tenderness, or persistent drainage should not be left until a routine appointment because active inflammation may need timely control.

Ask whether the scalp findings fit folliculitis decalvans, whether any area is already scarred, and how treatment activity will be monitored. Discuss the purpose and risks of an intralesional steroid injection, when oral antibiotics are appropriate, and what signs should trigger an earlier review.