Epidemiological, Clinical, and Therapeutic Insights into Folliculitis Decalvans in Skin of Color: A Retrospective Descriptive Study of 17 Cases.

Abstract

Introduction: Folliculitis decalvans (FD) is a neutrophilic scarring alopecia characterized by follicular pustules, crusts, and tufted hair. Its etiology remains unclear, though Staphylococcus aureus infection and immune dysfunction are implicated. This study investigates the clinical, dermoscopic, and therapeutic aspects of FD in a skin of color population. The objective of our study was to analyze the epidemiological profile, clinical diversity, diagnostic features, and treatment strategies for FD patients.

Methods: A retrospective, descriptive study of 17 FD patients was conducted at Ibn Sina University Hospital, Rabat, over 4 years. Diagnosis was based on clinical, dermoscopic, and histological findings. Data collected included demographics, disease onset, comorbidities, symptoms, severity grading, and therapeutic responses.

Results: The cohort comprised 17 patients (8 men, 9 women) with a median age of 37.2 years. Phototype IV was predominant (47.1%). The vertex was the most affected site (82.4%). Scarring alopecia was present in all cases, with perifollicular erythema (100%) and tufted hair (88.2%) being the most common dermoscopic findings. Grade 3 severity was observed in 55.5% of female patients. Topical and oral antibiotics, including doxycycline, were the most prescribed treatments. Resistance to treatment was more common in women.

Conclusions: FD in skin of color patients exhibits clinical, dermoscopic, and therapeutic patterns comparable to global data, though higher severity and pustule prevalence were noted. Doxycycline and topical agents remain key therapeutic options. Larger studies are needed to elucidate pathogenesis and optimize management strategies.