Background Folliculitis decalvans is a neutrophilic cicatricial alopecia whose etiology remains unknown. It is frequently associated with staphylococcal infections. We aimed to determine the rate of gram-negative infections in patients with folliculitis decalvans. Methods A retrospective chart review was performed of patients with biopsy-proven folliculitis decalvans seen at a tertiary hair referral center. The results of bacterial cultures were evaluated. Subjects were determined to have no infection, gram-positive infections, gram-negative infections, or mixed infections. Results Thirty-nine subjects were included in the study. Ninety-three cultures were performed. The majority of cultures were positive for staphylococci. Eleven patients (28%) had gram-negative infections of the scalp. Gram-negative infections comprised one-third of all cultures (33%). Conclusion We present the largest cohort of folliculitis decalvans patients with gram-negative infections, suggesting the need for routine bacterial cultures in patients who are not responsive to standard anti-staphylococcal antibiotics. Awareness of the incidence of these infections may lead to better therapeutic outcomes.

Background: In central centrifugal cicatricial alopecia (CCCA), a lymphocytic scarring alopecia that primarily affects black women, it has been postulated that there is a "pro-fibrotic" tendency and increased risk for systemic fibroproliferative disorders. Objective: To determine whether women with biopsy-proven CCCA have a greater likelihood of systemic fibroproliferative disorders (FPDs) of the lungs (interstitial lung disease), arteries (atherosclerosis of the aorta), liver (non-alcoholic steatohepatitis), kidney (end stage renal disease), or uterus (uterine leiomyoma). Methods: We conducted a retrospective matched cohort study evaluating 427 cases with biopsy-proven CCCA and 1281 age- and sex-matched controls. Results: Black women with biopsy-proven CCCA, were not more likely to have interstitial lung disease (ILD), atherosclerosis of the aorta, non-alcoholic steatohepatitis (NASH), end stage renal disease (ESRD), or uterine leiomyoma. Central centrifugal cicatricial alopecia was associated with a history of never smoking and higher body mass index. Conclusion: In this large cohort of biopsy-proven women with CCCA, there was no association with specific fibroproliferative disorders when compared with age and sex matched controls. Future longitudinal studies may help confirm these results.