Scalp Folliculitis: Symptoms, Causes, and Treatment
Reviewed by Angela Sheddan, DNP, FNP-BC
Written by Our Editorial Team
Despite its technical-sounding name, folliculitis isn’t a profoundly weird or rare condition — in fact, it’s a rather common skin condition that many people are likely to get throughout their lifetime.
You may very well have had folliculitis already and not known it, because folliculitis looks a lot like another skin-based infection: acne.
Though the two have a lot in common, they are also very different conditions, and knowing the difference may be important for saving your skin and your hair from some unfortunate side effects.
What Is Scalp Folliculitis?
Folliculitis is, at its simplest, a bacterial infection of the hair follicle caused by irritation. Bacterial folliculitis can appear anywhere on the body that you have hair follicles — anywhere, in other words, besides your palms and the soles of your feet.
It’s common to initially mistake folliculitis for acne vulgaris (or some fungal infections), because the two have much in common — they both develop due to infection, and may have similar appearances (folliculitis often looks like a whitehead).
But the differences between the two are important: while acne typically develops in places where the skin’s oil production may be more intense (the face, the chest, the back), folliculitis can happen in all of these places (and more) but is typically caused by irritation.
What Causes Scalp Folliculitis?
The causes of folliculitis are more complex than just “irritation.” In fact, irritation can come from many unexpected everyday activities.
Irritation can come from many sources. Shaving, waxing, tight clothes or equipment, ingrown hairs, as well as weight gain, medication and even hot tub usage may all cause folliculitis.
The central thread connecting these things is irritation — anything that causes skin to be rubbed, or stressed or otherwise pushed beyond its normal comfort zone can cause the irritation that leads to folliculitis infections.
In the scalp particularly, that may mean tight hair styles or messing with your hair, wearing tight helmets, hats or hair bands, using styling products that may cause buildup or irritation or shaving your head.
Folliculitis may also be more common for people with curly hair, especially in black men.
Typically, heat and moisture can also contribute to the risk of folliculitis — you’re more likely to develop it if you spend time sweating or exercising outdoors, or even just soaking in a hot tub.
That said, hot tub folliculitis isn’t necessarily going to occur in the scalp unless you’re submerging yourself, or sweating from the water’s heat.
How to Prevent or Get Rid of Scalp Folliculitis
There are many ways to prevent or get rid of folliculitis, but since we’re assuming you’re reading this with a current folliculitis outbreak, let’s start with how to get rid of it when you have it.
The first and most obvious way to get rid of a folliculitis outbreak is to stop doing what caused it in the first place.
In the scalp, that may mean something as simple as washing out styling gel or cutting down on the amount of time your hair spends styled up or under a hat or helmet.
Effective treatment may be as simple as applying a warm water compress to the area. The American Academy of Dermatology Association recommends doing this three to four times a day, for 15 to 20 minutes at a time until the acne-like lesions go away.
More serious causes of folliculitis may require medication. A topical antibiotic or oral antibiotic may be prescribed by a healthcare professional depending on various factors, including the severity of the outbreak and its location.
A healthcare professional may also recommend a mild topical steroid cream, oral isotretinoin or antihistamines, depending on your particular needs.
Prevention is similar — do as little to irritate the skin as possible.
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.
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, but 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.
Wearing loose clothing, making sure any hot tubs you use are clean and well maintained and washing bathing suits will also help you reduce your chances of getting folliculitis.
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Can Folliculitis Cause Hair Loss?
The question of folliculitis hair loss isn’t a simple one, but there are definitely ways in which folliculitis can cause hair loss.
Of the types of folliculitis, the one to worry about is folliculitis decalvans, which 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 condition in which the follicle ceases to function entirely and is replaced by scar tissue from the damage.
All of this can likewise cause staph infections, triggering excessive inflammatory responses from your body.
All of that, of course, may lead to a pretty nasty infection, which can require antimicrobial shampoo use for a long period of time to treat. It may also require systemic antibiotics.
Oh, and data shows that recurrence is common, so if this happens once, there’s a good chance it might happen again.
You can see how folliculitis shouldn’t be treated as just another bacterial infection. Take it seriously.
This hair loss due to folliculitis can be prevented mostly by addressing the problem before it gets out of hand, as once the damage is done, it’s often permanent.
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No matter the treatment plan, the best place to start is somewhere. Early action is the best hair loss prevention.
Taking Care of Scalp Folliculitis Before It Gets Serious
Because permanent hair loss is no one’s idea of a “good side effect,” the best course of action is to prevent and treat folliculitis before it ever gets that bad.
This starts with a diagnosis of folliculitis by a healthcare professional, followed by taking precautionary and appropriate reactionary steps when you see problems.
Yes, the honest truth is that one or two folliculitis papules may not be worth scheduling some quality time with your healthcare provider, but if you see them two, three or more times, or if the infrequent problem comes back more frequently or with more lesions, then it might be time to make the call.
They might let you know it’s mild, but they may also suggest treatments or lifestyle changes that’ll help you say goodbye to the problem once and for all.
If scalp folliculitis is already taking away precious follicles from your hairline, other treatments may be necessary.
A healthcare professional may suggest other ways of addressing hair loss symptoms, which may include minoxidil, which has been shown to increase blood flow to hair follicles (believed to encourage hair growth in the process).
Your shampoo might become a tool in the fight — herbal options may supplement hair health, as could important nutrients like vitamin A, vitamin D and biotin (like the stuff found in hers’ Biotin Gummy Multivitamins).
Whether you end up using any of these tools (or none of them), don’t ignore the problem — get the help you need before things get out of hand.
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