Folliculitis Decalvans — SCE Dermatology MCQ

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HardHair DisordersFolliculitis DecalvansSCE Dermatology

A 60-year-old man with folliculitis decalvans presents with boggy purulent areas on his scalp with tufted folliculitis (multiple hair shafts emerging from a single follicular opening) and progressive scarring alopecia. What is the most appropriate treatment?

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Correct answer: C — Prolonged oral Rifampicin and Clindamycin combination

Folliculitis decalvans is a neutrophilic primary cicatricial alopecia characterised by pustules, crusting, tufted folliculitis, and progressive scarring hair loss. Staphylococcus aureus is commonly isolated. Treatment with prolonged combination oral Rifampicin and Clindamycin (similar to HS regimen) is the most effective therapy, targeting both infection and inflammation. Duration is typically 10-12 weeks but longer courses may be needed. Relapse is common. Adjunctive treatments include intralesional corticosteroids and topical antibiotics. Scalp biopsy showing neutrophilic follicular destruction with perifollicular fibrosis confirms diagnosis.

Reference: BAD 2012 Cicatricial Alopecia Guidelines; BJD 2010