Clare Mahon, Lynda Spelman
Folliculitis decalvans is a rare, chronic cicatricial alopecia. The hair loss and scarring associated with this condition
has a significant impact on quality of life, and can cause significant emotional distress. It arises in adults and presents
as an expanding patch of scarring alopecia on the scalp, with pustules, crusts, hair tufts and perifollicular
hyperkeratosis. Without treatment, this can lead to irreversible progressive hair loss, an increased risk of squamous
cell carcinoma development, and has severe psychosocial sequelae for patients. Treatment is difficult for this
condition, with many cases where patients are refractory to topical therapies and oral antibiotics or isotretinoin.
There is emerging literature on the use of TNF-α inhibitors for this condition due to the role of TNF in the cellmediated
response. Here, we present another case of successful treatment of folliculitis decalavns with adalimumab
following failure of both medical and surgical therapy. This offers new insight into the effectiveness of TNF-α
inhibitors in the treatment of this neutrophilic alopecia in the post-operative setting and adds to the current
literature on TNF- α inhibitors in this condition.