Scalp folliculitis is a skin condition involving inflammation of the hair follicles. Causes of this inflammation may include ingrown hairs, infection, and medication side effects.
In this article, we discuss the symptoms, causes, complications, and treatments of scalp folliculitis.
Scalp folliculitis begins with small, inflamed bumps that appear along the hairline. Over time, these bumps grow larger and become more inflamed. Without treatment, scalp folliculitis can spread to hair follicles in the center or back of the head.
Other symptoms of folliculitis include:
- clusters of pus-filled or crusty sores
- closed pimples with whiteheads
- sores with brown or yellow scabs
- inflamed skin
- itching, burning, or tender skin
- mild fever
Folliculitis is a general term to describe an inflammation of the hair follicles. However, people can develop different types of folliculitis, depending on the cause. These can
Dissecting cellulitis of the scalp
In dissecting cellulitis of the scalp, or Hoffman disease, painful spots and swollen, pus-filled lumps appear on the scalp. It tends to start at the top of the head and spread to the back. There could also be patches of hair loss.
This condition is not due to a bacterial or fungal infection, but secondary infections can develop if a person does not treat it.
Pseudofolliculitis barbae
Pseudofolliculitis barbae, also known as barber’s itch or razor burn, is a type of folliculitis that develops from ingrown hairs. Razor burn usually leads to clusters of tiny, red bumps on the lower face, genitals, and other areas a person shaves.
Bacterial folliculitis
Bacterial infections are the
S. aureus lives on the skin and inside the nose, but it does not always cause an infection. However, an infection can develop on the scalp or other parts of the body if too much S. aureus grows on the skin or enters an open wound.
Gram-negative folliculitis
Gram-negative folliculitis occurs
Gram-negative folliculitis leads to large, pus-filled pimples in the deep layers of the skin. If people squeeze or pop these pimples, they may develop scars. Doctors can prescribe oral isotretinoin to treat most cases of gram-negative folliculitis.
Eosinophilic folliculitis
Eosinophilic folliculitis causes deep-set, pus-filled skin lesions that occur mostly on the face, neck, and scalp. This form of folliculitis affects infants and people with weakened immune systems. The lesions can leave dark spots on the skin, which is also known as hyperpigmentation.
Eosinophilic folliculitis affects males more often than females, according to the National Center for Advancing Translational Sciences (NCATS).
The causes of folliculitis
- bacterial infections
- yeast infections
- exposure to unchlorinated water in hot tubs
- ingrown hairs
- long-term use of topical antibiotics
- weakened immune system
There are several treatment options for scalp folliculitis. The following
- avoiding shaving the head for several days
- using a new, clean razor when shaving the head
- applying a warm compress to help soothe inflammation and drain pus
- applying antibiotic ointment to large nodules and open sores
- using mild antihistamines or topical steroid creams to reduce inflammation
- washing hair with an anti-dandruff shampoo
People may want to see a doctor if they have severe or persistent scalp folliculitis that does not improve with home or over-the-counter (OTC) treatments. A doctor can identify the underlying cause and prescribe an effective treatment. These can include:
- oral or topical antibiotics
- a prescription-strength topical steroid
- a topical antifungal ointment
- anti-microbial shampoo
- light therapy to kill bacteria and fungus on the scalp
- laser hair removal to destroy infected hair follicles
- surgically draining large pus-filled lesions
- oral retinoid medication
- steroid or biologic medication injections
Anyone can develop folliculitis. However, the following factors may increase a person’s risk for scalp folliculitis:
- frequently shaving the head
- wearing hats or helmets
- scratching or rubbing the scalp
- pulling at the hair
- having thick or curly hair
- being male
- using antibiotics over the long term
- having acne or dermatitis
- having a weakened immune system
If scalp folliculitis does not improve or worsens after trying home or OTC treatments, a person should contact a doctor.
People should also see a doctor if they develop:
- large pus-filled pimples under the skin
- open sores that drain pus
- thin or weak hair
- patches of hair loss
- a fever
In general, folliculitis is easily treatable. Many people can treat mild or superficial cases with OTC antibiotics, a medicated shampoo, and lifestyle changes.
Folliculitis due to ingrown hairs usually improves when a person stops shaving.
Doctors can treat severe folliculitis with a prescription-strength antifungal or antibiotic ointment, oral retinoids, or steroid or biologic medication injections. They can also prescribe a medicated shampoo that relieves itching and helps kill infectious microbes.
Eosinophilic folliculitis may become a chronic but mild condition and inflamed follicles can last weeks or even months. Doctors can prescribe effective treatments to help manage folliculitis outbreaks.
The following strategies may help prevent scalp folliculitis:
- washing the scalp regularly with a gentle shampoo
- rinsing out styling products as often as possible
- avoid wearing tight hats or helmets longer than necessary
- avoid shaving the head with a dull or unclean razor
- avoiding improperly treated hot tubs and pools
- washing the scalp immediately after sweating
To help reduce the risk of folliculitis, a person should treat their underlying conditions.
People who have medical conditions that affect their immune systems, such as rheumatoid arthritis, HIV, or diabetes, may want to consult a doctor to discuss prevention strategies.
People who have a long history of topical antibiotic use can discuss alternative treatment options with their doctors.
If a person does not treat scalp folliculitis, it can lead to:
- large, pus-filled furuncles or boils under the skin
- dark patches of skin
- scars
- permanent hair loss
- chronic or recurring follicle infections
- cellulitis or a bacterial skin infection
Folliculitis is not contagious. However, infectious agents, such as bacteria and fungus, can cause folliculitis to spread if people share razors, towels, hairbrushes, and other personal hygiene products.
Scalp folliculitis can be uncomfortable and painful. However, several OTC and prescription treatments can help relieve symptoms.
If a person has an underlying health condition that weakens their immune system, they may be at a higher risk of scalp folliculitis. They may wish to speak with a doctor, who can help manage their condition and prevent scalp folliculitis.