OSCE — Folliculitis decalvans

Brief (to candidate)

You will assess a patient with a presentation consistent with Folliculitis decalvans.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Folliculitis decalvans (Quinquaud disease) is a chronic, relapsing, PRIMARY NEUTROPHILIC cicatricial (scarring) alopecia of the scalp, defined by recurrent crops of follicular pustules on the scalp vertex and occiput together with the pathognomonic sign of TUFTED FOLLICULITIS (multiple hair shafts, classically 5-20, emerging from a single dilated follicular opening, the so-called 'doll's hair'). Staphylococcus aureus is cultured from lesional pustules in approximately 70% of cases, but FD is an abnormal, persistent neutrophilic inflammatory response to S. aureus (or its superantigens) and follicular contents rather than simple pyoderma. Untreated, the inflammatory cascade destroys follicular stem cells and causes permanent scarring alopecia.

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[1]