Understanding Scalp Folliculitis: A Frustrating Condition without a Clear Cause
Scalp folliculitis is a common inflammatory condition affecting the hair follicles on the scalp that is usually characterized by small, itchy pustules. It can be uncomfortable and distressing for those who experience it. Even more frustrating, many times these patients are misdiagnosed with seborrheic dermatitis, and prescribed antifungal shampoos without benefit. Here, I’ll aim to address what scalp folliculitis is, what the possible cause is, and available treatment options.
What is Scalp Folliculitis?
Folliculitis refers to the inflammation of hair follicles, The condition can affect individuals of all ages and backgrounds, although certain factors may increase susceptibility.
Causes of Scalp Folliculitis
The cause of scalp folliculitis is not entirely clear. Some hypothesize that there is a bacterial component, specifically staph aureus. There are many reasons to believe this hypothesis. For one, staph aureus is often cultured from pustules in scalp folliculitis. Additionally, scalp folliculitis also responds to doxycycline, an antibiotic. However, in two studies performed on patients with chronic scalp folliculitis, only 15% to 30% of patients had cultures positive to staph aureus, putting this hypothesis into question. Other potential causes of scalp folliculitis that are less common include viral infections, occlusion from heavy oils or products, or fungal infections such as pityrosporum.
Symptoms of Scalp Folliculitis
The symptoms of scalp folliculitis can vary in severity but typically include:
• Small Red Bumps: These can resemble acne and may be filled with pus.
• Itching: The affected area often becomes itchy, leading to discomfort.
• Tenderness: The scalp may feel sore or tender to the touch.
• Crusting and Scabbing: As the pustules heal, they may crust over and form scabs.
• Hair Loss: In severe cases, folliculitis can lead to temporary hair loss in the affected areas.
Diagnosis
Diagnosing scalp folliculitis typically involves a physical examination by a dermatologist. In some cases, a sample of the pustule’s contents may be taken to identify the specific bacteria or fungi causing the infection. In rare cases, a biopsy is performed to exclude other conditions that may mimic folliculitis, such as tinea capitis.
Treatment Options
The treatment of scalp folliculitis depends on its cause and severity. Common treatments include:
• Topical Antibiotics: For mild bacterial folliculitis, topical antibiotics such as clindamycin may be prescribed.
• Oral Antibiotics: In more severe or widespread cases, oral antibiotics like doxycycline or cephalexin may be necessary.
• Topical Steroids: To reduce inflammation and itching, topical corticosteroids may be prescribed. However, their use should be monitored to avoid potential side effects.
• Isotretinoin: This is the closest treatment we have for a cure for scalp folliculitis. This is used in cases where folliculitis is recalcitrant to steroids and antibiotics.
Less commonly used treatments include:
• Antifungal Treatments: If a fungal infection is identified, antifungal shampoos containing ketoconazole or selenium sulfide can be effective.
• Home Remedies: Warm compresses can help soothe the affected area and promote drainage of pus. Tea tree oil, known for its antibacterial and antifungal properties, may also provide relief when diluted and applied to the scalp.
Prevention
While the below measures may help, ultimately scalp folliculitis may not be preventable with these measures alone. Patients can minimize risk factors for scalp folliculitis by:
• Practicing Good Hygiene: Maintaining good scalp hygiene and avoiding irritants can help prevent and manage folliculitis. This includes using gentle, non-comedogenic hair products and avoiding tight hairstyles.
• Protecting the Scalp: If you wear helmets or hats frequently, ensure they are clean and fit properly to avoid unnecessary friction.
Conclusion
Scalp folliculitis, while often a mild and manageable condition, can be chronic, uncomfortable, and may even cause hair loss. If you suspect you have scalp folliculitis, consult with one of our board-certified dermatologists. We can help curate a treatment plan for you that will provide long-term relief.
