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Therapeutic Approach

Folliculitis decalvans, also known as “tufted folliculitis” due to the clinical feature of several hairs arising from a single follicle, is the most common neutrophilic scarring alopecia. It is characterized by perifollicular pustules and inflammation that destroys the follicle leading to round or oval patches of permanent hair loss. Treatment may reduce symptoms and control progression, but there is no curative therapy to date. First-line therapy includes topical and/or oral antibiotics depending on disease extent, often in combination with topical or intralesional steroids. More severe or extensive disease requires oral antibiotics or other systemic therapies, such as isotretinoin or dapsone. Maintenance therapy may be necessary. See Table 82-1.

Table 82-1Folliculitis Decalvans Treatment Table

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