skip to main content

Folliculitis Decalvans — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateHair DisordersFolliculitis DecalvansSCE Dermatology

A 28-year-old woman presents with a rapidly progressive scarring alopecia. Scalp biopsy shows neutrophilic folliculitis with destruction of hair follicles. There are tufted hairs (polytrichia — multiple hairs emerging from a single follicular opening). Culture grows Staphylococcus aureus. She has no acne or HS. What is the diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Folliculitis decalvans

Folliculitis decalvans (FD) is a neutrophilic cicatricial alopecia characterised by recurrent pustules, crusting, and tufted folliculitis (polytrichia) with progressive scarring hair loss. S. aureus is consistently cultured but the disease is not simply a bacterial infection — it represents an aberrant host immune response to staphylococcal antigens. Tufted hairs are a characteristic clinical sign. First-line treatment is prolonged oral Rifampicin + Clindamycin combination (10-12 weeks). Topical antibiotics, intralesional corticosteroids, and long-term oral Doxycycline may maintain remission. Relapse is common. FD differs from dissecting cellulitis (which shows fluctuant abscesses and interconnecting sinuses).

Reference: BAD 2012 Cicatricial Alopecia; BJD