Follicular Degeneration Syndrome
FDS is a form of CCCA that occurs in African Americans with a female to male ratio of 3:1. Patients present with an area of slowly expanding scarring alopecia on the vertex or crown. The condition may be asymptomatic or accompanied by pruritus or tenderness. Often the lesion appears not to be inflamed, but there may be erythema and/or pustules at the periphery of the area of scarring. Scalp biopsy in FDS shows degeneration of the internal root sheaths below the level of the isthmus. Involved follicles may also demonstrate eccentric placement of the hair shaft with thinning of follicular epithelium, concentric lamellar perifollicular fibrosis, superficial perifollicular and perivascular lymphocytic inflammation, and in late lesions, destruction of follicles with resultant hair granulomas. The etiology of FDS is unknown, however hair care practices such as chemical straightening and use of hot combs may play a role in some patients.
FDS is difficult to treat. There are no studies examining the benefit of various treatment modalities for this condition. Discontinuation of chemical processing and hot combs is recommended. Intralesional steroids can be given into the periphery of a lesion that is still actively expanding. Superpotent topical steroids could also be used for short periods of time. Topical or systemic antibiotics can be given if there is a component of pustular folliculitis. Topical minoxidil can also be tried, but the patient must realize that there is little to no chance of hair regrowth in the older central portion of the lesion. Eventually the condition burns out.