What Is Follicular Degeneration Syndrome

Introduction

Follicular degeneration syndrome (FDS) is a chronic and progressive type of scarring alopecia that results in permanent hair loss, starting in the centre of the scalp. FDS is also known as central centrifugal cicatricial alopecia (CCCA) or hot comb alopecia. The purpose of this article is to provide an overview of the causes, symptoms, diagnosis, treatment, and prevention of FDS.

Causes 

The exact cause and mechanism of FDS are still unknown and under investigation. However, some possible causes  include:

• Genetic predisposition: Some studies have suggested that FDS may have a hereditary component and that certain genes may increase the risk of developing FDS. Examples include…
• Inflammation: FDS may be triggered or worsened by inflammation of the scalp, which can damage the hair follicles and lead to scarring. Inflammation can be caused by various factors, such as infection, trauma, or autoimmune disorders
• Environmental factors: FDS may be influenced by external factors, such as chemical treatments, heat styling, tight braids, extensions, or wigs. These factors can cause mechanical stress, thermal injury, or chemical damage to the scalp and hair follicles

Risk factors - this is a repetition of the points before

Some risk factors for FDS are:

• Genetic predisposition: Some studies have suggested that FDS may have a hereditary component and that certain genes may increase the risk of developing FDS¹
• Inflammation: FDS may be triggered or worsened by inflammation of the scalp, which can damage the hair follicles and lead to scarring. Inflammation can be caused by various factors, such as infection, trauma, or autoimmune disorders²
• Environmental factors: FDS may be influenced by external factors, such as chemical treatments, heat styling, tight braids, extensions, or wigs. These factors can cause mechanical stress, thermal injury, or chemical damage to the scalp and hair follicles²
• Ethnic background: FDS most commonly affects middle-aged women of an African-American background.

These are some of the risk factors for FDS, but more research is needed to understand how they interact and contribute to the development of this condition.

Symptoms:

• Patchy hair loss that starts in the centre of the scalp and spreads outward
• Redness, scaling, itching, burning, pain, or blisters on the affected areas
• Scarring of the scalp that destroys the hair follicles and prevents hair regrowth
• Loss of hair volume, density, and length
• Changes in hair texture, such as dryness, brittleness, or coarseness

If you notice any of these symptoms, you should consult a dermatologist as soon as possible. Early diagnosis and treatment can help prevent further hair loss and scarring.¹

Diagnosis

Follicular degeneration syndrome (FDS) is a type of scarring alopecia that results in permanent hair loss. FDS can be diagnosed by a dermatologist through tests such as: 

Clinical examination: A dermatologist can inspect the scalp for signs of hair loss, inflammation, scarring, or other abnormalities. FDS typically presents as an area of baldness on the crown or vertex of the scalp that expands outward.¹ The affected areas may have redness, scaling, itching, burning, pain, or blisters.¹

Scalp biopsy: A dermatologist can take a small sample of the scalp tissue and examine it under a microscope. A scalp biopsy can confirm the diagnosis of FDS and rule out other causes of hair loss. FDS shows destruction of the hair follicles and scarring of the scalp tissue.¹

Other tests: A dermatologist may also perform other tests to check for any underlying conditions that may be associated with FDS, such as infection, inflammation, or autoimmune disorders. These may include blood tests, culture tests, or immunofluorescence tests.^{1, 3}

Treatment

There is no cure for FDS, but there are some treatment options that may help slow down the progression of the condition and reduce the symptoms. Some of the treatment options are:

• Anti-inflammatory medications: These drugs can help reduce the inflammation and itching on the scalp. They can be applied topically as creams or gels or taken orally as pills. An example of an anti-inflammatory medications is hydroxychloroquine.¹²
• Antibiotics or antifungals: These drugs can help treat any infection that may be causing or worsening FDS. They can be applied topically as creams or ointments or taken orally as pills. Examples of antibiotics or antifungals are clindamycin, mupirocin, and ketoconazole³
• Corticosteroids: These drugs can help suppress the immune system and reduce the inflammation and scarring on the scalp. They can be injected into the affected areas, applied topically as creams or ointments, or taken orally as pills. Examples of corticosteroids are triamcinolone, clobetasol, and prednisone^{1, 2}
• Immunosuppressants: These drugs can help modulate the immune system and prevent it from attacking the hair follicles. They can be taken orally as pills or injected into the bloodstream. Examples of immunosuppressants are methotrexate, cyclosporine, and mycophenolate¹
• Hair transplantation: This is a surgical procedure that involves moving healthy hair follicles from one part of the scalp to another. It can help restore some hair density and coverage on the bald areas. However, it is not suitable for everyone, and it may not prevent further hair loss.²

These are some of the treatment options for FDS, but they may not work for everyone and may have side effects. Therefore, it is important to consult a dermatologist before starting any treatment and to follow their instructions carefully.

Prevention

There is no cure for FDS, but there are some ways to prevent or reduce the progression of the condition and protect the hair and scalp. Some prevention tips are:

• Avoid harsh chemicals, excessive heat, or tension on the scalp: These can cause mechanical stress, thermal injury, or chemical damage to the scalp and hair follicles, which may trigger or worsen FDS.¹ It is advisable to avoid chemical treatments, such as relaxers, perms, or dyes; heat styling, such as blow-drying, curling, or straightening; and tight hairstyles, such as braids, cornrows, extensions, or wigs. Instead, opt for gentle and natural products and styles that do not pull or strain the scalp.
• Maintain good scalp hygiene: Keeping the scalp clean and moisturised can help prevent infection, inflammation, or dryness that may contribute to FDS.^2,3 It is recommended to wash the scalp regularly with a mild shampoo and conditioner and to apply a moisturising oil or cream to the scalp after washing. Avoid scratching or picking at the scalp, as this can cause further damage and scarring
• Seek professional advice: If you notice any signs of hair loss, redness, scaling, itching, burning, pain, or blisters on the scalp, you should consult a dermatologist as soon as possible. Early diagnosis and treatment can help slow down the progression of FDS and prevent further hair loss and scarring.² A dermatologist can also prescribe appropriate medications or procedures to treat FDS and monitor your condition

Summary

Follicular degeneration syndrome (FDS) is a chronic and progressive type of scarring alopecia that results in permanent hair loss. It most commonly affects middle-aged African women and starts in the centre of the scalp. The exact cause and mechanism of FDS are still unknown, but some possible factors are genetic predisposition, inflammation, infection, trauma, or environmental factors. FDS can be diagnosed by a dermatologist through clinical examination, scalp biopsy, and other tests.  Treatments include anti-inflammatory medications, antibiotics, antifungals, corticosteroids, immunosuppressants, or hair transplantation, but there is no cure for the condition. It can be prevented or reduced by avoiding harsh chemicals, excessive heat, or tension on the scalp, maintaining good scalp hygiene, using moisturising products, and seeking professional advice.