Scalp folliculitis: Symptoms, pictures, causes, shampoos and creams - Medical News Today

Scalp folliculitis is a skin condition where the hair follicles on 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 of scalp folliculitis.

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A person with scalp folliculitis may experience clusters of pus-filled or crusty sores.
Image credit: Dr Raimo Suhonen | DermNet New Zealand.

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 include:

Dissecting cellulitis of the scalp

Dissecting cellulitis of the scalp, or Hoffman disease, is where large nodules appear on the scalp. 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 these.

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 where a person regularly shaves.

Although anyone can develop razor burn, people with thick or curly hair may have a higher risk.

Bacterial folliculitis

Bacterial infections are the most common cause of folliculitis. Staphylococcus aureus (S. aureus) is the bacterium 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 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 it enters an open wound.

Gram-negative folliculitis

Gram-negative folliculitis occurs most often when a person uses oral antibiotics, particularly tetracyclines. It could also develop after long-term use of topical antibiotics, where antibiotic-resistant bacteria grow on different parts of the body, including the scalp.

Gram-negative folliculitis leads to large, pus-filled pimples that sit in the deep layers of the skin. People may develop scars if they squeeze or pop these pimples. Doctors can prescribe oral isotretinoin to treat most cases of gram-negative folliculitis.

Eosinophilic folliculitis

Eosinophilic folliculitis causes deep-set, pus-filled skin lesions to 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).

Learn more about different types of infections here.

The causes of folliculitis include:

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.

There are several treatment options for scalp folliculitis. The following home remedies may help treat mild cases:

• 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

Scalp folliculitis is not a medical emergency. People can even treat mild cases at home. However, 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

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

A person should contact a doctor if they have scalp folliculitis that does not improve, or worsens after trying home or OTC treatments.

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 for up to 1 week.

Doctors can treat severe folliculitis with a prescription-strength antifungal or antibiotic ointment. They can also prescribe a medicated shampoo that relieves itching, and helps kill infectious microbes.

Eosinophilic folliculitis may become a chronic, but mild condition. 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 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.

Scalp folliculitis can be uncomfortable and painful. However, there are several OTC and prescription treatments that 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 to a doctor, who can help manage their condition and prevent scalp folliculitis.