When is steroid injection recommended for folliculitis decalvans?

Folliculitis decalvans is an inflammatory scalp condition that can cause pustules, crusting, soreness and grouped hairs emerging from one follicle opening. Persistent inflammation can destroy follicles and leave scarring. A dermatologist may inject steroid medicine into a limited, active area to reduce local inflammation, often as one part of a wider plan.

Injection does not clear infection on its own and cannot recreate follicles already lost to scar tissue. Diagnosis may involve scalp examination, a swab or biopsy because other causes of pustules and scarring can look similar. The treatment site, skin thickness and the pattern of activity guide the decision.

Arrange review for recurring scalp pustules, crusts, tenderness, burning, tufted hairs or expanding hair loss. Keep the scalp routine gentle and avoid picking, harsh scrubs and unapproved injections. Tell the clinician about antibiotics, anti-inflammatory medicines, allergies and earlier scalp treatments. After treatment, monitor the sites for worsening pain, drainage, skin thinning or a colour change, and attend planned follow-up.

Seek prompt assessment if pustules multiply quickly, redness spreads, pain becomes marked, drainage increases or you develop fever. Rapidly expanding scarring hair loss needs timely dermatology review because active inflammation can continue beneath apparently quiet skin. Facial swelling or breathing difficulty after an injection requires emergency help.

Ask how the diagnosis was confirmed, whether infection is contributing, and which scalp areas are active enough to treat. Ask what broader therapy is needed, how hair loss and inflammation will be tracked, what local effects to expect, and which changes should prompt an earlier appointment.