Folliculitis decalvans is a rare, inflammatory disease of the scalp, which can evolve to irreversible cicatricial alopecia. Even though the mechanisms of this disease are not fully known, it is considered that Staphylococcus aureus plays an important role in its etiopathogenesis. We report the case of a 60 years old patient that was admitted to our department for multiple pruriginous, alopecic atrophic plaques, with numerous ulcerations covered by serohematic crusts and scales, painful pustules on the vertex and parietal-occipital regions of the scalp. The diagnosis was confirmed by clinical, pathological examination, and trichoscopy, which were the key factors to a successful treatment.
The particularity of the case resides in the long, unfavorable evolution, incorrect treatment of the patient, being misdiagnosed for a long time in other dermatological services. All this underlines the complexity of cicatricial alopecia and the difficulty of diagnosis, which may often lead to inappropriate treatment.