Linear Circumscribed Scleroderma-Like Folliculitis Decalvans: Yet Another Face of a Protean Condition

Since Quinquaud's original report of folliculitis decalvans (FD), further clinical variants have been described on the basis of common histopathological and microbiological findings. Histopathology reveals a neutrophilic primary scarring alopecia, and microbiological studies invariably reveal pathogenic strains of Staphylococcus aureus. The presence of thickening of lesional skin in FD has been previously described. We report a new presentation of FD, clinically mimicking linear circumscribed scleroderma of the scalp. Overlapping features of the scarring alopecias may blur the distinction between different conditions that ultimately share the common final pathway of replacement of follicle by fibrous tissue. Therefore, a careful patient history, clinical examination including dermoscopy, microbiological studies, and a scalp biopsy for histopathology, and immunofluorescence studies are prerequisites to an accurate diagnosis and appropriate treatment of the respective condition. The case is presented to illustrate the clinical variability in presentation of FD and to underline the necessity of performing a biopsy for an accurate diagnosis in the scarring alopecias.