Scalp folliculitis is a skin condition that occurs when the hair follicles on the scalp become inflamed. This results in pustules, whiteheads, or other pimple-like bumps on the scalp that can be painful.
Scalp folliculitis is a skin condition that occurs when the hair follicles on the scalp become inflamed. This results in pustules, whiteheads, or other pimple-like bumps on the scalp that can be painful. Scalp folliculitis is typically a fairly harmless condition, but it can be itchy or uncomfortable — reason enough to explore treatment.
You may be wondering, what is folliculitis? Folliculitis is caused by bacterial infection, injury, virus, or fungi. It can occur anywhere on the body where there are hair follicles (so everywhere except the lips, eyelids, palms, and soles of the feet). Folliculitis is also sometimes called the following:
Barber’s itch
Hot tub rash (hot tub folliculitis)
Razor bumps (pseudofolliculitis barbae)
Shaving rash
Here, we’re focusing specifically on scalp folliculitis.
Scalp folliculitis manifests in several ways:
Small, itchy bumps: These may be red, white, or yellow and can appear around the hair follicles. They can be mistaken for acne.
Pain or tenderness: The affected areas might be sore or painful to touch.
Redness and swelling: The skin around the follicles can become red and swollen.
Crusting and flaking: The scalp may develop crusty patches or flaky skin. It may also develop blisters that break open or crust over.
Hair loss: In severe cases, hair in the affected area may fall out.
Burning or stinging sensation: The scalp might feel like it's burning or stinging.
You know that an inflamed or infected hair follicle is what causes folliculitis, but how does that happen in the first place? Scalp folliculitis is caused when microorganisms enter the hair follicles through tiny cuts, abrasions, or via the sebaceous glands.
Scalp folliculitis can be caused by a few factors, including:
Bacterial infections, like staph. The bacteria staphylococcus aureus (staph) always exists on the skin’s surface, but can create problems when it enters the body through a cut or wound.
Fungal infections like Malassezia: This type of yeast is typically present on the skin but can overgrow and cause folliculitis, especially in oily or humid conditions.
Excess sebum production. When you have too much sebum, it can clog hair follicles, potentially leading to scalp folliculitis.
Ingrown hairs. Infected ingrown hairs are a type of folliculitis that may be present on the scalp or other commonly shaved areas.
Risk factors for scalp folliculitis include:
Poor hygiene: Not washing the scalp regularly can lead to the buildup of oils and dead skin cells, which in turn promotes bacterial growth.
Occlusive hair products: Using heavy oils, gels, or hair sprays can block hair follicles, increasing the risk of infection.
Sweating: Excessive sweating can create a moist environment that promotes bacterial growth.
Friction: Wearing tight hats or helmets can cause friction, irritating the hair follicles and causing bumps.
Shaving: Shaving the scalp can cause tiny cuts that allow bacteria to enter. Plus, when skin is damp and hot (as it is in the shower), it can be easier to damage hair follicles. Plucking and waxing hair can also contribute.
Pre-existing skin conditions: Conditions like acne, dermatitis, or eczema can make the scalp more susceptible to folliculitis.
Compromised immune system: A weakened immune system can reduce the body's ability to fight infections.
Certain medications: Long-term use of antibiotics or steroids can alter the skin's natural flora and make it more prone to infections. Certain drugs like lithium and cyclosporine may also contribute to folliculitis.
Weight gain: The link between weight and folliculitis is not entirely clear, but folliculitis can be caused or made worse by skin-on-skin contact or friction.
If you suspect you have folliculitis (or if you’re not sure what’s going on with your skin), it’s always a good idea to see a dermatologist. Scalp folliculitis may be diagnosed in several ways.
Medical History: Your healthcare provider will ask questions about your symptoms and recent activities or changes in your hygiene or routine that could contribute to folliculitis.
Exam: The provider will look at your scalp, paying careful attention to signs of infection, redness, and bumps.
Skin Swab: A swab of the affected area may be taken to be looked at more closely under a microscope. This helps to identify the specific bacteria, yeast, or fungi causing the infection.
Biopsy: In rare cases, a small skin sample might be taken for examination under a microscope to rule out other conditions.
The question of scalp folliculitis and hair loss isn’t simple, but there are ways in which folliculitis can cause hair loss.
Folliculitis decalvans is a more intense type of folliculitis that can cause hair loss if left untreated. The condition causes intense granulocytic inflammation, which destroys the follicle and damages the scalp.
If enough damage is done, it can trigger a form of scarring alopecia, a type of permanent hair loss in which the follicle ceases to function entirely and is replaced by scar tissue from the damage.
Folliculitis looks a lot like acne, another skin-based infection that also occurs in hair follicles. Despite their similarities, acne and scalp folliculitis are not the same condition and should be treated differently.
Here’s how to treat scalp folliculitis.
Medication
More serious causes of folliculitis may require medication.
A healthcare professional may prescribe a topical or oral antibiotic depending on various factors, including the severity of the outbreak and its location.
Oral Antibiotics: Oral antibiotics like dicloxacillin or cephalexin may be prescribed for bacterial folliculitis.
Antifungal Medications: Antifungal creams or oral medications like fluconazole or terbinafine may be needed if a fungal infection is suspected.
Antiviral Medications: Antiviral drugs such as acyclovir may be prescribed for viral folliculitis.
Topical Antibiotics: Prescription-strength antibiotics like clindamycin or erythromycin.
Topical Steroids: In cases of severe inflammation, a mild corticosteroid cream may be used to reduce swelling and itching.
Other Medications: In some cases, medications that do not fall neatly into any of the above categories, like antihistamines, itraconazole, or isotretinoin, may be prescribed.
Non-prescription Treatments: A healthcare provider may also suggest trying products like an antibacterial wash.
Apply a Warm Compress
Some mild cases of folliculitis may be treated with a warm water compress applied to the area. The American Academy of Dermatology Association recommends doing this three to four times daily for 15 to 20 minutes until the bumps begin to clear.
There are many ways to prevent or get rid of folliculitis. The first and most obvious way to prevent a future folliculitis outbreak is to stop doing what caused it in the first place.
On the scalp, that may mean washing out styling gel or reducing how much time your hair spends styled up or under a hat or helmet. Let’s take a look at some other ways to prevent the discomfort from returning:
Practice Good Hygiene
Try to wash your towels regularly and avoid sharing wash clothes or towels. Keep your scalp and hair clean. If you wear hats, consider cleaning them as well.
Use Non-Comedogenic Skin Care
Non-comedogenic skin care does not contain heavy ingredients like mineral oils that may clog pores, so seek these out.
You may also be able to find hair care that’s specifically labeled as non-comedogenic, but if not, look for shampoos, conditioners, and styling products that do not contain coconut oil, silicone (sometimes labeled as dimethicone), or many oils, including argan, almond, and pumpkin seed.
Take a Break From Shaving
One of the biggest self-inflicted causes of folliculitis is shaving, so if you’re seeing a lot of folliculitis outbreaks in areas where you shave, your razor is probably to blame. It helps to use a clean, sharp razor, but experts (including the American Osteopathic College of Dermatology) recommend a pause in shaving for at least three months to give the area time to heal and new hair to grow.
Obvious measures like using a clean razor, changing blades regularly, and cleaning the area with soap before shaving may already be part of your routine. Still, other changes could further reduce your chances of infection.
This may mean shaving less often or switching from a razor to an electric razor to reduce irritation to the hair follicle.
Be Mindful of Hot Tubs
You’ll probably only get scalp folliculitis from a hot tub if you submerge yourself in it, but generally, it’s best to ensure that any hot tubs you use are clean and well-maintained.
Dry Sweat Quickly
If you’re going to be running or active and sweating a lot (or even just hanging out in a hot and humid climate), consider bringing a towel to wipe your head. Sweat can contribute to folliculitis by creating a moist environment for bacteria to thrive.
Skip Coal Tar
According to the AAD, some people develop folliculitis when they apply medication, such as coal tar, to their skin.
Folliculitis is generally not harmful if treated, so it's essential to seek treatment before it worsens. Your healthcare provider can help diagnose, treat, and give you tips for preventing folliculitis from recurring.
If folliculitis hair loss is a concern, you can visit your primary care provider or a dermatologist. The easiest thing to do? Connect with a healthcare provider online.