Hydroxychloroquine may be beneficial as an adjuvant therapy for folliculitis decalvans: a 5-year retrospective study with 49 patients

Folliculitis decalvans (FD) is a chronic and recurrent neutrophilic scarring alopecia that mostly affects the vertex scalp of young male patients. It manifests as painful alopecic lesions surrounded by pustules, tuftings and intense scalp fibrosis. However, the occurrence of less active or 'lichen planopilaris-like' forms of FD questions the exact role of Staphylococcus aureus in the pathogenic mechanism of this disease. The management of FD is very challenging, as relapses are frequent and prolonged use of combined antibiotics is often required. Recent evidence showed the presence of S. aureus and lymphocytic inflammation also in nonlesional FD scalp. This suggested the potential use of immunomodulating drugs such as hydroxychloroquine to better control the chronic inflammatory status of this -disease.