Scalp Infections: Causes, Symptoms, and Treatment - Verywell Health

A scalp infection is caused by bacteria and fungi that entered the hair follicles or skin of the scalp. Having a scalp infection can lead to various types of skin rashes on the scalp as well as hair loss.

Treatment for scalp infections will vary depending on the cause.  

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Folliculitis

Folliculitis is an infection in which one or more hair follicles become inflamed and swollen. It is most commonly caused by bacteria, but it can also develop because of a virus, parasite, or fungus.

Scalp folliculitis causes small, very itchy pustules to form on the scalp, often most troublesome on the frontal hairline. There may be many or only a small number of lesions (abnormalities in the skin). They are often itchy, and become sore and crusted.

The cause of scalp folliculitis is not exactly clear. It is generally considered to be an inflammatory reaction to parts of the hair follicle, particularly the microorganisms like:

• Bacteria, such as Staphylococcus aureus
• Yeast, specifically the Malassezia species
• Mites, which are insect-like organisms

Treatment

In cases of mild folliculitis, treatment may not be necessary and the condition will clear up on its own. Treatment options may include:

• Topical antiseptics such as benzoyl peroxide or hypochlorite may be used to help slow the growth of bacteria or other organisms on the skin that are causing the infection.
• Topical antibiotics such as fusidic acid, clindamycin, or mupirocin may be needed to help with the overgrowth of bacteria. Antibiotics may also be used with medical drainage of boils if they have developed. Medical drainage involves having the boils drained at the doctor's office.
• Oral antibiotics may be used if the condition has progressed and if you have other symptoms such as fever. Systemic antibiotics are taken orally and could include dicloxacillin and cefadroxil.
• Mild topical steroid lotions or creams may help with the itchiness.
• Oral antihistamines may also help with the itchiness.

When to See a Doctor

Some cases of folliculitis can cause scarring. Seeing a dermatologist early can help clear up the condition quickly and prevent that from happening.

Fungal Infections

In some cases, fungus can lead to a scalp infection. Yeast, a type of fungus, that can lead to a scalp infection include Candida and Malassezia.

Symptoms of a scalp yeast infection caused by Candida may include:

• Crusts on the scalp that may lead to hair loss
• Purple or red patches of skin
• White, flaky scales on the scalp
• Patches of red and itchy skin
• Pustules filled with pus that appear like pimples

Malassezia can cause scalp infections such as folliculitis, seborrheic dermatitis, and pityriasis versicolor.

Treatment

Treatment options for a fungal infection affecting the scalp include:

• Antifungals: Antifungal medications can come in ointments, shampoos, or foams. The most notable antifungal used for a scalp yeast infection is fluconazole. Shampoos containing ketoconazole may also be used to help treat the infection.
• Over-the-counter (OTC) shampoos: If the infection is caused by the Malassezia yeast, shampoos with active ingredients, such as selenium sulfide, zinc pyrithione, and coal tar, may be used.
• Corticosteroid shampoos: In some cases, corticosteroids can help relieve inflammation caused by the infection. Shampoos containing fluocinolone, ketoconazole, or betamethasone valerate will be used.

Impetigo

Impetigo is a very contagious skin infection that can be caused by Group A Streptococcus (Group A strep) and Staphylococcus aureus, also known as staph. Although anyone can get impetigo, it is most commonly found in children between the ages of 2 and 5.

The bacteria enter the scalp through open cuts or sores, insect bites, or other rashes. Symptoms of impetigo include:

• Red and itchy sores that can break, causing the release of pus or clear fluid
• Scabbing of the sores that are honey-colored or yellow

Treatment

Since impetigo is a bacterial infection, the only way to treat it is through the use of antibiotics. If the affected area is small, OTC antibiotics such as fusidic acid, mupirocin, and retapamulin may be used.

Topical antibiotics are typically preferred, but in some cases oral antibiotics may be needed if the infection is severe or spreading. Oral antibiotics that are often used include doxycycline, amoxicillin, and clindamycin. A new treatment for impetigo, known as Foamix, has shown promise in helping clear up the infection.

Since impetigo is contagious, the wounds on the scalp should be covered as best you can to avoid spreading the infection to others.

Although severe complications of this skin infection are rare, kidney problems may occur following an impetigo infection in some cases. That is why it's important to seek treatment promptly.

Lichen Planus

Lichen planus causes swelling and irritation of the skin. It is an autoimmune disease that affects hair follicles. Typically, lichen planus of the scalp affects adults between the ages of 30 and 60, and females are more likely to experience it. When it develops on the scalp, it is referred to as lichen planopilaris.

Symptoms of lichen planus on the scalp include:

• Scaly skin on the scalp and around the hair follicles
• Redness
• Bald patches where hair loss has occurred
• Pain, burning, and itching on the scalp
• Small red bumps around clusters of hair
• Possible hair loss 

Treatment

Treatment options for lichen planus affecting the scalp include:

• Antimalarials, such as hydroxychloroquine
• Immunosuppressive medications, such as methotrexate and cyclosporine
• High-potency topical corticosteroids, such as triamcinolone acetonide
• Diabetes medications, such as pioglitazone
• Antirheumatic medications, such as mycophenolate mofetil
• Oral antibiotic medications, such as doxycycline
• Antifungal medications, such as griseofulvin

Ringworm (Tinea Capitis)

Ringworm is a fungal infection that can affect the skin on any part of the body. It causes a circular rash that appears as a ring.

When ringworm affects the scalp, it can lead to symptoms such as:

• A scaly, circular bald spot
• Itchiness in the affected area
• Redness
• Cracked skin 

Treatment

Treatment for ringworm on the scalp requires oral antifungal medications. The antifungals used most to treat ringworm can include:

• Terbinafine
• Itraconazole
• Posaconazole
• Griseofulvin

It could take up to three months for the antifungal medication to clear up the infection completely.

Seborrheic Dermatitis

Seborrheic dermatitis causes scaly patches and red skin on the scalp. The exact cause of this condition is not clear, but many factors can lead to its development, such as a Malassezia fungal infection, inflammatory reactions in the body, and a family history of the condition.

Common symptoms of seborrheic dermatitis affecting the scalp include:

• Dandruff
• Red scales on the skin
• Inflamed hair follicles

Treatment

Treatment focuses on reducing the symptoms of seborrheic dermatitis and managing flare-ups, and may include:

• OTC dandruff shampoos with selenium sulfide, zinc pyrithione, or coal tar
• Antifungal shampoos containing ketoconazole and ciclopirox
• Topical corticosteroids such as betamethasone valerate and fluocinolone to help reduce inflammation on the scalp
• Shampoos containing tea tree oil

Summary

Scalp infections are a result of bacteria or fungi that entered the hair follicles or skin of the scalp. There are many different types, including folliculitis, impetigo, lichen planus, and ringworm. Depending on the cause, each can be treated with antibiotics or antifungal medications as well as over-the-counter steroid creams to reduce uncomfortable symptoms like itching.

Frequently Asked Questions

Can you grow your hair back after a scalp infection?

Hair loss that occurs during a scalp infection is only temporary in most cases. In more severe cases or with some conditions, hair loss may be permanent if irreparable damage is caused to the hair follicles. It's important to seek help from a dermatologist as soon as you notice symptoms.

How contagious is a ringworm scalp infection?

Ringworm is very contagious. It can spread through skin-to-skin contact. It can also be spread through indirect contact. For example, if a person has a ringworm infection and you touch their clothing or another object that has come into contact with their infected skin, you could contract ringworm.

How do you treat a scalp infection at home?

Treating a scalp infection at home isn't recommended because you won't know what treatment is right until you've had a proper diagnosis. For some conditions, home remedies can be used to help relieve symptoms, such as over-the-counter anti-itch creams or a cold compress to help with the itching and pain. If you think you may have a scalp infection, treatment at home should only be explored after getting a diagnosis from your primary care physician or dermatologist.