Folliculitis Decalvans – Clinical
Folliculitis decalvans is a form of CCCA characterized by the presence of numerous pustules at the periphery of the scarred area(s). The lesions may be quite painful and patients often complain of drainage and/or bleeding on the pillow at night when the disease is active. tufted folliculitis, characterized by several (up to 30) terminal hairs emerging from the same follicular orifice in an area of scarring, is often seen in patients with folliculitis decalvans. The etiology of folliculitis decalvans is unknown, however, Staph aureus is often cultured from the pustules. Some authors postulate that the condition results from an altered immune response of some patients to superantigens produced by the bacteria found in hair follicles.
Scalp biopsy in folliculitis decalvans demonstrates prominent superficial and deep follicular and perifollicular inflammation consisting of lymphocytes, plasma cells, neutrophils, and macrophages. It is common to see a follicle in which the epithelium is completely destroyed and replaced by macrophages and other inflammatory cells. Gram positive bacteria can often be seen in the superficial areas of suppurative inflammation. The pathologist needs to rule out a fungal folliculitis which can show identical histological findings.