Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]Sep 25, 2015

Using targeted radiation therapy to treat folliculitis decalvans

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Mar 9, 2026

Abstract

A 45-year-old male patient with folliculitis decalvans experienced significant symptom relief after receiving a total of 17 Gy of intensity-modulated radiotherapy.

Folliculitis decalvans is characterized by chronic hair follicle inflammation and can cause pain and discomfort.
The patient initially received 11.0 Gy of radiation, which resulted in a marked decrease in symptoms, but not complete resolution.
A second radiation treatment of 6 Gy was administered 4 months later, leading to almost complete hair loss in the affected area and elimination of pain and itching.
Follow-up after 26 months indicated no recurrence of draining lesions or exudation.
Discrete hair regrowth occurred in the occipital region 12 months post-treatment, which is being managed with laser therapy.

Simplified

BACKGROUND: Folliculitis decalvans (FD) is a form of primary neutrophilic scarring alopecia that is characterized clinically by chronic suppurative folliculitis and often associated with pruritus or even pain. Treatment of FD is often difficult. Herein, we report a case of recalcitrant and painful folliculitis decalvans refractory to antibiotic and anti-inflammatory therapies, which was successfully treated by intensity-modulated radiotherapy (IMRT) in order to irreversibly eliminate hair follicles that prove to be one etiological trigger.

CASE PRESENTATION: A 45-year-old male patient with a refractory FD presented with a crusting suppurative folliculitis and atrophic scarring patches on the scalp associated with pain and pruritus. We attempted relief of symptoms by reducing scalp inflammation and eliminating hair follicles through radiation. We delivered 11.0 Gy in two radiation series using tomotherapy, 5.0 Gy in 5 equivalent fractions as a first radiation course. The symptoms markedly decreased but did not totally disappear. Therefore, we delivered a second radiation series 4 months later with an additional 6 Gy. This led to almost complete epilation on the scalp and abolished pain and pruritus on the capillitium. The patient was regularly followed up until 26 months after radiotherapy. Draining lesions or exudation did not recur. He only experienced discrete hair regrowth in the occipital region with folliculitis 12 months after radiotherapy. These residual lesions are currently treated with laser epilation therapy.

CONCLUSION: A radical approach to eliminating hair follicles by repeated radiation therapy may induce lasting relief of symptoms in chronic suppurative FD associated with persistent trichodynia.

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Using targeted radiation therapy to treat folliculitis decalvans

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