Folliculitis decalvans is a form of alopecia (hair loss) that involves scarring. It is characterized by redness, swelling and pustules around the hair follicle (folliculitis) that leads to destruction of the follicle and consequent permanent hair loss. Folliculitis decalvans affects both men and women and may onset during adolescence or at any time in adult life. The exact cause is unknown. In most cases Staphylococcus aureus (bacteria) can be isolated from the pustules. However, the role of the bacteria is not clear. What are the signs and symptoms? Any hairy region may be involved. It is usually confined to the scalp but can involve other sites including the beard, underarm, pubic hair, lower legs, thighs and arms. Usually there are no symptoms but sometimes the affected area may be itchy or painful. The disease may remain limited to a few small patches or may progress over time causing extensive hair loss. In western medicine, the disease can be controlled to some degree by using medications. Usually oral antibiotics such as minocycline, tetracycline, rifampicin, and clindamycin the common form of treatment. In some severe forms, the addition of an oral corticosteroid may be necessary. This form of treatment is not always the most effective. In Chinese medicine, folliculitis decalvans is related to the inner organs, a hormone imbalance, and excessive toxic heat in the body are believed to be the cause for the disease. Due to its chronic history, the majority of patients may take too many antibiotics, but that can kill off normal defense bacteria such as the ones that live in the bowel and vagina. This causes the patients’ immunity to drop to a low level. In Chinese medicine, we use natural herbs to clear toxic heat and improve immunity. Many herbs have anti-inflammatory functions, but they do not have side-effects. With the use of the herbs the immunity system improves, and that prevents the reoccurrence of the disease.