What causes scalp folliculitis

A contagious condition, scalp folliculitis is an inflammation of the hair follicles. The main cause of scalp folliculitis is damage to the hair follicle. Once it's damaged, bacteria, mites or fungus are able to invade the follicles. An excessively oily scalp can exacerbate scalp folliculitis. Thankfully, by treating your scalp with care, you can avoid this skin-compromising condition.

Here are some scalp-saving strategies:

• Avoid wearing restrictive clothing or hats.
• Steer clear of harsh chemicals and solvents.
• Shave slowly and gently.
• Avoid excess perspiration when possible.
• Minimize time spent exposed to heat and humidity by avoiding the sauna, hot tub, whirlpool or improperly chlorinated pools.
• Reduce exposure to coal tar, pitch or creosote, which can irritate the follicles.

What are the symptoms?

Known also as "malassezia furfur," scalp folliculitis has mild or severe symptoms:

• Mild. Many types of scalp folliculitis are superficial, meaning the infection occurs within the portion of the hair follicle closest to the skin. Mild cases usually appear in the form of small, itchy whiteheads along the hairline and by the forehead or ears. They usually respond well to over-the-counter treatments or may heal on their own. Complications with mild forms are unlikely, although it's important to stay on top of treatment as the infection can recur or spread.

• Severe. Folliculitis that develops deep within the pore is often more severe and tougher to treat, requiring a visit to the doctor. Deep folliculitis typically appears in the form of hardened, red bumps that are tender to the touch.

  iVillage explains the following complications of severe folliculitis:

  • Skin boils. Occurring deep within the skin, boils begin as small, red or pink bumps that fill with pus over time, often painful to the touch.

  • Scarring. Unfortunately, even after the infection clears, deep folliculitis can cause scars in the form of rough, raised blemishes or dark patches of skin.

  • Hair follicle destruction. Severe folliculitis can damage the hair follicle to the point where hair no longer grows.

  • Cellulitis. This is a bacterial infection of the skin and soft tissues beneath the skin that causes infection and inflammation, swelling, redness, pain and warmth.

Although the name suggests otherwise, it's possible for scalp folliculitis to occur anywhere hair follicles are present, including the face, neck, legs and back. Depending on the cause and the location of occurrence, there are several different types of scalp folliculitis. For a proper diagnosis, see your doctor.

Who's at risk?

Although anyone can suffer from scalp folliculitis, certain people may be more prone to an outbreak. According to Mayo Clinic, the following conditions or medications increase your risk of having scalp folliculitis:

• Compromised immune system or HIV, diabetes or long-term cancer treatment

• Chronic skin conditions like eczema or dermatitis

• Acute acne or long-term antibiotic acne treatment

• Trauma to the skin after surgery

• Obesity

• Topical corticosteroid therapy

In addition, people living in a warm or very humid environment have a higher risk of developing folliculitis.

How is it treated?

Severe cases of scalp folliculitis can progress into more serious conditions, including acne necrotica miliaris and perifolliculitis capitis. These medical conditions may require antibiotic treatment and must be treated by a doctor, as they can lead to scarring or hair loss.

Other serious cases can require antifungal medication and corticosteroids. Mild cases can be effectively treated at home, though some cases may disappear without treatment. The below tips can help get you started:

• Cleanse the skin. Be sure to cleanse the skin along the hairline and keep it as free from oil as possible. Andrew Weil, M.D., recommends using products that contain tea tree oil, because it's an effective antibacterial and antifungal agent.

  • Product pick. Try an antibacterial cleansing product that contains tea tree extracts such as Cellex-C Fresh Complexion Foaming Gel to remove excess oil and bacteria.

• Shampoo often. Dr. Weil also recommends frequent washing to manage scalp folliculitis and prevent recurring cases. Also, antidandruff shampoos that contain antifungal agents such as ketoconazole or ciclopirox can help.

  • Product pick. Hair care products designed specifically for seborrhea are known to remedy scalp folliculitis. Try Alterna Life Solutions Scalp Therapy Shampoo.

• Apply a topical treatment. Salicylic acid can help to reduce whiteheads and gently exfoliate dry, flakey skin, keeping the scalp clear of build-up and helping to cut down on flare-ups. Apply a salicylic acid formula to the area with a cotton swab. But avoid benzoyl peroxide. Although it's an excellent treatment for acne, benzoyl peroxide can damage or lighten the hair (similar to hydrogen peroxide).

  • Product pick. Stubborn spots on the scalp can be treated with Bliss Change Your Spots, a salicylic acid product suitable for use on or near the hairline.

Special considerations

Because this condition is highly contagious, managing and treating all cases of scalp folliculitis is vitally important. Here's how to avoid spreading the disease (or re-infecting yourself) during any stage of an active breakout:

• Cleanliness is key. Use clean, dry towels when bathing or swimming and change your pillowcase nightly.

• Say "no" to sharing. Avoid sharing towels, combs, brushes or other hair accessories.

• Comb with care. Brush the hair gently to avoid abrading the pustules.

• Seek medical treatment. If your symptoms don't improve within three to four days, or the outbreaks worsen, seek medical attention.

For more information about how to manage scalp folliculitis, don't hesitate to talk to your dermatologist or family doctor.

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See also:

Complete Acne Handbook

Scalp Conditions Handbook