Folliculitis decalvans (FD) is a type of primary scarring (cicatricial) alopecia where chronic inflammation targets hair follicles on the scalp. It can cause recurrent pustules, crusting, pain, and a classic sign called tufted hairs (multiple hairs emerging from one opening). Because FD can destroy follicles and replace them with scar tissue, early diagnosis and treatment matter.
Medical note: This article is for general education and does not provide personal medical advice. For the full roadmap, start here: Hair Loss (Complete Guide).
Quick navigation
- What it is (plain English)
- What it usually looks like
- Symptoms you may notice
- Why it can cause permanent hair loss
- What causes it? (what we know)
- Trichoscopy clues
- How it’s diagnosed (culture + biopsy)
- Conditions that can look similar
- What to do (safe next steps)
- Treatment overview (high-level)
- Prognosis & expectations
- When to see a doctor
- FAQ
- References
What is folliculitis decalvans?
Folliculitis decalvans is a chronic inflammatory condition of hair follicles (most often on the scalp) that can lead to scarring alopecia. It is often placed under neutrophilic primary cicatricial alopecias. A related pattern called tufted folliculitis is often considered part of the same spectrum.
On our site, this belongs under: Scarring Alopecia (Hub) → Primary Scarring Alopecia.
What it usually looks like
FD often appears as recurrent inflamed “follicle-centered” bumps on the scalp. Common findings include:
- Follicular pustules (small pus-filled bumps around hairs)
- Yellow-brown crusts and erosions (especially during flares)
- Tufted hairs (“doll’s hair” / multiple hairs exiting one opening)
- Patchy scarring hair loss that slowly expands
- Shiny smooth areas or reduced follicle openings in scarred zones
Symptoms you may notice
- Pain or tenderness (common in active inflammation)
- Itch or burning
- Recurrent “flare-ups” with new pustules or crusting
- Hair shedding from inflamed areas (followed by permanent loss in scarred regions)
Why it can cause permanent hair loss
FD is a scarring alopecia. If inflammation repeatedly damages the follicle, the body can replace the follicle unit with scar tissue. Once follicles are scarred, regrowth is limited. The practical goal is to stop active disease before more follicles are lost.
What causes it? (what we know)
The exact cause is not fully understood, but many references highlight a frequent association with Staphylococcus aureus and an abnormal inflammatory response in susceptible individuals. FD is not contagious, but bacteria can contribute to ongoing inflammation and flares.
Trichoscopy clues
Trichoscopy (scalp dermoscopy) can support diagnosis and track activity. Findings commonly described include:
- Tufted hairs (multiple hair shafts emerging from one follicular opening)
- Perifollicular erythema (redness around follicles)
- Perifollicular scale
- Pustules and yellow crusts
- Loss of follicular openings in scarred zones
How it’s diagnosed (culture + biopsy)
Diagnosis is usually based on clinical pattern + scalp exam, often supported by:
- Bacterial culture of pustules/crusts (to guide antibiotics when needed)
- Trichoscopy to document tufting + inflammatory activity
- Scalp biopsy when diagnosis is unclear or when distinguishing look-alikes
Practical biopsy tip: if a biopsy is needed, clinicians often sample an active edge (where pustules/erythema are present) rather than a fully scarred center.
On our site: How Hair Loss Is Diagnosed • Scalp Biopsy
Conditions that can look similar (important)
- Dissecting cellulitis of the scalp: deeper nodules, draining sinuses; part of the follicular occlusion spectrum.
- Tinea capitis: scale + broken hairs/black dots (especially in children).
Read: Tinea Capitis. - LPP/FFA: scarring alopecia with perifollicular scale/erythema, usually without pustules as the main feature.
Read: LPP + FFA. - Discoid lupus (DLE): scarring plaques with scale/pigment change; biopsy can distinguish.
Read: Discoid Lupus (DLE). - CCCA: crown-centered scarring alopecia; pustules are not the typical headline feature.
Read: CCCA.
What to do (safe next steps)
- Book a dermatology visit early: recurrent pustules/crusts with hair loss can be scarring—early control matters.
- Don’t pick crusts: picking can worsen irritation and secondary infection.
- Ask about culture: a targeted culture can guide therapy rather than repeated “random antibiotics.”
- Track flares: photos every 2–4 weeks (same lighting) help document activity and response.
For red flags, see: When to See a Doctor.
Treatment overview (high-level)
Treatment is individualized. The main goal is to reduce inflammation, suppress flares, and prevent further scarring. Options often discussed in dermatology references include:
- Antiseptic/antimicrobial shampoos (adjunct care in many plans)
- Topical antibiotics (for mild disease or as add-on therapy)
- Oral antibiotics (commonly tetracyclines; sometimes combination therapy such as clindamycin + rifampicin under clinician supervision)
- Anti-inflammatory scalp treatments (for example, topical corticosteroids in selected cases)
- For refractory disease: clinician-directed options may include isotretinoin, dapsone, or other systemic approaches (evidence varies)
Key point: the goal is often stabilization (stopping progression) rather than full regrowth in scarred areas.
Read: Treatment Overview.
Prognosis & expectations
FD is usually chronic with flares and remissions. With the right plan, many people can reduce flare frequency and slow progression. Hair regrowth is limited in fully scarred areas, so early control is the most important strategy.
Read: Prognosis & Expectations.
When to see a doctor (red flags)
- Rapidly spreading painful pustules or crusting
- Marked scalp pain, swelling, or drainage
- Fever or feeling unwell (possible deeper infection)
- Shiny smooth patches or visible loss of follicle openings (possible scarring)
Read: When to See a Doctor.
FAQ
Is folliculitis decalvans contagious?
No. FD is not considered contagious. Bacteria can be involved, but the condition reflects an inflammatory process in the scalp follicles.
Can the hair grow back?
Regrowth is more likely in early, non-scarred areas. Once follicles are replaced by scar tissue, regrowth is limited. Treatment focuses on stopping progression.
What does “tufted hairs” mean?
It means multiple hair shafts appear to come out of a single opening (a “tuft”). This is a classic supportive clue in FD.
Do I need a scalp biopsy?
Not always. Many cases are diagnosed clinically with trichoscopy and (sometimes) culture. A biopsy can help when the diagnosis is uncertain or when distinguishing FD from other scarring alopecias.
References (trusted medical sources)
- DermNet: Folliculitis decalvans (overview)
- British Association of Dermatologists: Folliculitis decalvans (patient leaflet)
- Rambhia et al (2018): Updates in therapeutics for folliculitis decalvans (PMC)
- Fabris et al (2013): Dermoscopy in folliculitis decalvans (PMC)
- Filbrandt et al (2013): Primary cicatricial alopecia diagnosis/treatment (PMC)
- Cleveland Clinic: Folliculitis decalvans (plain-language overview)
Last updated: February 04, 2026.
