Scalp folliculitis is a skin condition where the hair follicles in the scalp become inflamed or irritated. Bacteria, yeast, and other factors, such as ingrown hairs, can all cause scalp folliculitis.
In this article, we discuss the symptoms, causes, complications, and treatments for scalp folliculitis.
Scalp folliculitis begins with small, inflamed bumps that appear along the hairline. Over time, these bumps get bigger and more inflamed. Left untreated, scalp folliculitis can spread to hair follicles in the center or back of the head.
Other symptoms of folliculitis
- clumps of pus-filled or crusty sores
- closed buttons with white dots
- sores with brown or yellow scabs
- inflamed skin
- itching, burning, or sensitive skin
- slight fever
Folliculitis is a general term to describe inflammation of the hair follicles. However, people can develop different types of folliculitis, depending on the cause. These can
Scalp dissecting cellulitis
Pseudofolliculitis of the beard
Pseudofolliculitis of the beard, also known as barber itch or razor burn, is a type of folliculitis that develops from ingrown hairs. Razor burn usually results in clusters of tiny red bumps on the lower face, genitals, and other areas where a person shaves regularly.
Although anyone can develop razor burn, people with thick or curly hair may have a higher risk.
Bacterial infections are the most common cause of folliculitis. Staphylococcus aureus (S. aureus) is the bacteria most often responsible for bacterial folliculitis. There are 30 different types of Staphylococcus bacteria, but S. aureus causes most infections.
S. aureus lives on the skin and inside the nose, but it does not always cause infection. However, an infection can develop on the scalp or other parts of the body, if too S. aureus grows on the skin or enters an open wound.
Gram negative folliculitis
Gram-negative folliculitis occurs most of the time when a person is using oral antibiotics, especially tetracyclines. It could also develop after long-term use of topical antibiotics, where antibiotic-resistant bacteria thrive on different parts of the body, including the scalp.
Gram-negative folliculitis causes large pus-filled pimples that sit in the deep layers of the skin. People can develop scars if they squeeze or pop these pimples. Doctors can prescribe oral isotretinoin to treat most cases of Gram-negative folliculitis.
Eosinophilic folliculitis causes deep, pus-filled skin lesions, mainly on the face, neck, and scalp. This form of folliculitis affects infants and people with weakened immune systems. The lesions can leave brown spots on the skin, also called hyperpigmentation.
Eosinophilic folliculitis affects men more often than women, according to the National Center for the Advancement of Translational Sciences (NCATS).
Learn more about the different types of infections here.
The causes of folliculitis
Folliculitis is not contagious. However, infectious agents, such as bacteria and fungi, can cause folliculitis to spread if people share razors, towels, hairbrushes, and other personal hygiene products.
There are several treatment options for scalp folliculitis. What follows
- avoiding shaving your head for several days
- using a new, clean razor to shave your head
- apply a warm compress to help soothe inflammation and drain pus
- applying antibiotic ointment to large nodules and open wounds
- using mild antihistamines or topical steroid creams to reduce inflammation
- washing hair with anti-dandruff shampoo
People may want to see a doctor if they have severe or persistent folliculitis of the scalp that does not improve with home or over-the-counter (OTC) treatments. A doctor can identify the underlying cause and prescribe effective treatment. These can understand:
- oral or topical antibiotics
- a prescription topical steroid
- topical antifungal ointment
- anti-microbial shampoo
- light therapy to kill bacteria and fungi on the scalp
- laser hair removal to destroy infected hair follicles
- surgical drainage of large pus-filled lesions
Scalp folliculitis is not a medical emergency. People can even treat mild cases at home. However, if a person does not treat scalp folliculitis, they
- large boils or pus-filled boils under the skin
- dark spots on the skin
- permanent hair loss
- chronic or recurrent follicular infections
- cellulitis or bacterial infection of the skin
Anyone can develop folliculitis. However, the following
- shave your head frequently
- wear hats or helmets
- scratching or rubbing the scalp
- pull on the hair
- have thick or curly hair
- to be a man
- long-term use of antibiotics
- have acne or dermatitis
- have a weakened immune system
A person should contact a doctor if they have scalp folliculitis that does not improve or gets worse after trying home or over-the-counter treatments.
People should also see a doctor if they develop:
- large pimples filled with pus 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 over-the-counter antibiotics, medicated shampoo, and lifestyle changes.
Folliculitis due to ingrown hairs usually improves when a person stops shaving for up to 1 week.
Doctors can treat severe folliculitis with prescription antifungal or antibiotic ointment. They may also prescribe a medicated shampoo that relieves itching and helps kill infectious germs.
Eosinophilic folliculitis can develop into a chronic but mild disease. According to NCATS, inflamed follicles usually last 1 or 2 weeks and reappear every 1 or 2 months. Doctors can prescribe effective treatments to help manage outbreaks of folliculitis.
The following strategies can help prevent scalp folliculitis:
- regularly wash the scalp with a mild shampoo
- rinse styling products as often as possible
- avoid wearing tight hats or helmets longer than necessary
- avoiding shaving your head with a dull or dirty razor
- avoid badly treated spas and swimming pools
- washing the scalp immediately after sweating
To help reduce the risk of folliculitis, a person should treat their underlying conditions.
People who have health problems that affect their immune system, such as rheumatoid arthritis, HIV, or diabetes, may want to see a doctor to discuss prevention strategies.
People who have a long history of using topical antibiotics can discuss alternative treatment options with their doctors.
Scalp folliculitis can be uncomfortable and painful. However, there are several over-the-counter and prescription treatments that can help relieve symptoms.
If a person has an underlying health problem that weakens their immune system, they may be at a higher risk for scalp folliculitis. They may wish to speak to a doctor, who can help them manage their condition and prevent scalp folliculitis.