Scalp Folliculitis – Causes, Symptoms and Treatment

What is Scalp Folliculitis?

Folliculitis is a condition in which the hair follicles get inflamed. It can occur anywhere in the body where there is hair.  

Scalp folliculitis is a condition where the follicles on the scalp become irritated and inflamed. This usually occurs when there is a bacterial or fungal infection on the scalp.

It normally can be treated at home, but conditions with severe symptoms like scarring, pain on the follicles and continued itching lead to acute hair loss and needs to be checked by a physician. 

How is this condition caused?

There can be many reasons for the hair follicles to be damaged. But the main cause for follicular inflammation is due to infection-causing organisms like bacteria or fungi. When these organisms act on the follicles, the follicles get swollen and inflamed. The inflammation and scars look similar to acne and cause itching and redness. 

Some of the other causes of scalp folliculitis include:

• Overuse of chemical-based hair products
• Wearing sports helmets or hats for a long time
• Hairstyles that keep the hair tight or might pull the strands
• Scratching the head more often
• Pulling or twisting the hair frequently
• Shaving the head frequently

Few other prevailing complications like individuals with acne prone skin, with curly or coarse hair, taking medication/therapy for any underlying skin condition, can increase the chances of developing scalp folliculitis.

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What are the symptoms of scalp folliculitis?

Folliculitis signs and symptoms include:

• White-headed pimples, or clusters of small red bumps which develop around hair follicles
• Burning, itchy skin
• A large swollen bump or mass
• Painful, tender skin
• Pus-filled blisters which breaks open and crust over

People with folliculitis might feel itchy and would want to scratch. This urge may be uncontrollable and when scratched the bumps break and bleed leading to severe infection on the spots. This apparently worsens the condition and damages the hair follicles permanently. 

With folliculitis, there is a high risk of the bumps getting spread all over the scalp. Scratching on the results of the bump in spreading. When there is a bump on a particular spot, it spreads to the other follicles and increases in size. The bumps after spreading may also get more inflamed.

Since the condition often starts along the hairline, most patients experience severe hair fall. 

Few other symptoms of scalp folliculitis are:

• Yellowish-brown sores
• Itching
• Scarring
• Burning or stinging sensation on the affected spots
• Pain or tenderness on the scarred spots
• Pus formation on the breakouts

How can you manage scalp folliculitis at home?

Few cases of scalp folliculitis with very mild symptoms can be cured at home. Most importantly, it is necessary to stop the cause that led to the condition. 

For instance, shaving is one of the causes of this condition. If the affected person reduces the frequency of shaving or changes the technique of shaving after being inflicted by scalp folliculitis, it may help in getting rid of the symptoms and in the long run, the condition might also vanish. 

Many people will have fewer to no symptoms within a certain time frame of following home treatment while the rest with severe symptoms are required to consult the dermatologist.

Home-based remedies that will help to reduce the symptoms:

• Warm compress – A warm, damp cloth can be applied on the affected spots for at least 3 or 4 times a day. This will help to reduce the inflammation and pacify the itching or burning sensation. It can also help to drain the pus. However,  treatment with too hot a  compress needs to be avoided, as it may worsen the bumps.
• Using antibacterial soap – Gently washing the skin twice a day with an antibacterial soap will help to reduce the infection on the scalp. This can be done when the folliculitis is developed along the hairline. It is also important to dry the area with a clean towel after washing with the soap, as any traces of the soap left should be wiped off. 
• Using anti-dandruff shampoo – Washing the scalp with an anti dandruff shampoo helps to kill the infection-causing organisms on the follicles. Shampoos that contain anti-fungal properties such as ketoconazole, ciclopirox or tea tree oil are preferred. If after using the shampoo, any side effects are experienced, it is important to consult the dermatologist immediately.
• Applying cortisone cream – A cortisone cream can be applied on the affected spots to help reduce the inflammation and get rid of itching. It will also help to reduce the burning sensation on the scalp. 
• Using antibiotic ointments – When the scalp folliculitis is developed due to bacteria, applying an antibiotic ointment like Neosporin on the affected spots can help to kill the organism and gradually reduce the infection.
• Avoid hot water – Washing the hair or scalp with hot water may worsen the symptoms. Hence, it is advisable to use lukewarm water to wash the scalp. This can help to reduce the irritation on the affected spots.
• Avoid shaving frequently – Shaving the head frequently needs to be avoided. The individual can try switching to an electric shaver instead of hand razors as electric ones may be effective and less painful. After shaving lotion that doesn’t contain any chemical formulations can be applied on the scalp after shaving. 
• Using clean towels and combs – Keeping the towel, comb, hats, pillows, etc that come in contact with your scalp clean is essential. Washing these items regularly is necessary to avoid developing the symptoms further.
• Keeping the scalp clean – Washing the scalp properly after using any product or oil on the scalp is important. This helps to clear off any remains of the products that can potentially lead to problems.

In addition to the above remedies, it is important to follow proper scalp hygiene after the condition is sorted. 

When should you consult a dermatologist?

Scalp folliculitis is usually treatable at home. Cases with severe symptoms require a dermatologist’s intervention. 

The following treatments may be prescribed .

Medicines

• Pills or creams to control infection: For mild infections, a doctor may recommend an antibiotic cream, gel or lotion. Oral antibiotics are not used routinely for folliculitis. However, for recurrent or a severe infection, the doctor may prescribe them.
• Shampoos, pills or creams to fight fungal infections 
• Pills or creams to reduce inflammation: If it is a mild eosinophilic folliculitis, the doctor may recommend a steroid cream to ease the itching

Other interventions

• Minor surgery. If you have a large boil or carbuncle, your doctor may make a small incision in it to drain the pus. 
• Laser hair removal. If other treatments fail, long-term hair removal with laser therapy may clear up the infection. 

The dermatologist has to be contacted in the following situations:

• Continued pain on the spots
• Persistent irritation and burning sensation
• Unstoppable draining of pus from the bumps
• Fever, fatigue or any related symptoms
• Severe spreading of the bumps on and around the scalp