What To Know about Scalp Folliculitis

Scalp folliculitis is a skin condition characterized by irritation and swelling of the hair follicles on your scalp. Hair follicles are the areas of your skin that surround the roots of your hair strands. Irritation of this area can cause tiny, itchy, red bumps around your scalp. Most cases of scalp folliculitis are temporary, but in rare cases, it can be chronic (recurring).

The most common cause of folliculitis is a bacterial infection, but fungal infections and viruses can also cause inflammation in your skin. Folliculitis is more common in people who live in humid climates or who frequently wear headgear, such as a helmet.

Consult a dermatologist (a doctor who specializes in skin, hair, and nail conditions) if you notice any signs of scalp folliculitis that do not go away after a few days.

Symptoms 

At first glance, scalp folliculitis may look like acne on your scalp. It often appears as small, red pimples or sores that crust at the edges. Pustular bumps are filled with fluid (pus), making them appear more raised. Other symptoms of scalp folliculitis include swelling, itchiness, and pain or tenderness.

Frequently experiencing folliculitis can damage your hair follicles, leading to temporary hair loss and scarring of the affected areas of the skin.

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What Causes Scalp Folliculitis?

Scalp folliculitis is caused by a bacterial, viral, or fungal infection that gets into tiny cuts or breaks in the skin on your scalp. Infections from common bacteria, like Staphylococcus aureus (staph), are the most common cause.

Folliculitis can also occur if your hair follicles frequently become clogged with oil, sweat, and dead skin cells. Another type of scalp folliculitis, Demodex folliculitis, is caused by an excess of Demodex mites (face mites) on your skin. It is normal for some Demodex mites to live on your skin, but having too many can cause them to build up in your hair follicles, leading to folliculitis.

Although having curly or coily hair does not cause scalp folliculitis, it can increase your risk of developing the condition. Men of African descent with coarse, curly, or coily beards are more likely to experience Pseudofolliculitis barbae, commonly called barber's itch. This type of folliculitis causes razor bumps in the beard area.

Ingrown hairs after shaving can also lead to folliculitis. Exfoliating the beard area with a scrub once or twice weekly can help prevent razor bumps that can lead to folliculitis. Do not exfoliate immediately after shaving to avoid irritating the skin. Some people find using an electric razor (set to a length of 0.5-1 mm) helps reduce irritation.

Risk Factors 

Folliculitis usually comes from excessive friction or a build-up of oils on your skin. Wearing hats frequently, especially in humid environments, may increase your risk of scalp folliculitis. Men are also more likely to experience Malassezia folliculitis—a type of skin irritation caused by yeast overgrowth on the skin.

Risk factors of scalp folliculitis may include:

• Sweating a lot
• Using harsh skin care products that irritate or damage the follicle
• Taking medications like Lithobid (lithium) or Neoral (cyclosporine)
• Consuming immunosuppressants, which reduce your body's natural immune response
• Having other preexisting health conditions like diabetes
• Wearing hats or helmets in hot environments

Diagnosis

Your healthcare provider or dermatologist can diagnose scalp folliculitis with a physical examination. Along with inspecting your scalp, they will also ask about your medical history and whether you are experiencing symptoms elsewhere on your skin.

Your healthcare provider may also conduct the following diagnostic tests:

• Routine blood tests: A complete blood count (CBC), chemistry panel, or inflammation markers can be used to rule out other health conditions.
• Dermatoscopy: This involves using a magnifying device to see your scalp more closely to examine potential causes of your folliculitis.
• Skin swab or culture test: A provider may perform a skin swab to identify the presence of bacteria, fungi, or yeast.
• Biopsy: Although rare for folliculitis, a provider may examine a small skin sample under a microscope.

Treatments for Scalp Folliculitis

Scalp folliculitis can generally be treated using home remedies. Mild cases will usually resolve if you apply a warm compress to the affected area for 5-10 minutes several times a day. More severe cases may require treatment from a dermatologist. 

Treatments for moderate to severe scalp folliculitis include:

• Antifungal medications
• Anti-parasitic agents
• Antiviral medications
• Antihistamines to relieve itchiness, such as topical Benadryl (diphenhydramine)
• Topical or oral corticosteroids

Your provider may recommend one or more of these treatments depending on the cause of your folliculitis. For example, suppose your case is caused by a fungus. In that case, they will likely prescribe an antifungal medication to treat the fungus and an antihistamine to soothe symptoms like itchiness.

In severe cases, your provider may recommend the acne treatment Accutane (isotretinoin) to reduce oil build-up on your scalp. However, taking Accutane has many risks, including cirrhosis (liver damage) and severe dehydration.

Other Aesthetic or Medical Treatments

Laser hair removal prevents hair regrowth from follicles. This treatment is most commonly suited for folliculitis that occurs on facial hair.

To treat severe folliculitis anywhere on your skin, your provider may also recommend: 

• Dermabrasion to remove the top layers of skin
• Electrolysis or surgery to remove hair follicles
• Injectable corticosteroids
• Cryotherapy (freezing)

Prevention

Regularly cleansing your scalp prevents product and oil build-up that can lead to folliculitis. A dermatologist may suggest using antibacterial or antifungal shampoos to further prevent infections. Skincare products containing retinoids, salicylic acid, and glycolic acid can also reduce build-up around hair follicles.

If you shave your facial hair regularly, consider using chemical hair removal creams or an electric razor instead of handheld razors. Practice shaving in the direction your hair grows to prevent inflammation from ingrown hairs. It's also important to regularly clean and disinfect your shaving tools to prevent bacterial infections.

Complications

Scalp folliculitis can usually resolve on its own with at-home treatment.

When left untreated, scalp folliculitis can cause:

• Boils (furuncles): This infection causes pus-filled bumps that can become swollen and painful.
• Cellulitis: This common bacterial infection affects layers of skin underneath your hair follicles.
• Pus pockets (abscesses): This moderate to severe infection causes pockets of pus to form under the skin.
• Scars: Recurring or severe folliculitis can leave scars behind on your scalp.
• Dark spots: Temporary dark spots may appear if your body produces more pigment (color) in response to swelling and healing as you receive treatment.
• Hair loss: Severe cases of scalp folliculitis can damage your hair follicles and cause them to stop producing hair.

A Quick Review

Scalp folliculitis is irritation of hair follicles on your scalp, ranging from mild and temporary to severe and chronic. Keeping your scalp free of build-up and thoroughly cleaning shaving tools can help prevent folliculitis.

Keep track of your symptoms for your healthcare provider if you notice it lasting more than a couple of days. For recurrent folliculitis, consult a healthcare provider to receive the proper treatment.