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Itchy scalp: Folliculitis could be the cause of your itching and hair loss

Women suffering from itchy scalp
Démangeaison du cuir chevelu : La folliculite pourrait être à l'origine de vos démangeaisons et de votre perte de cheveux 1 - 2024

Itchy scalps can be painful or just plain annoying. Persistent scalp itching can lead to irritation and trauma to the skin barrier. So it's important to understand the cause of your itching and how to treat it.

scalp folliculitis
Démangeaison du cuir chevelu : La folliculite pourrait être à l'origine de vos démangeaisons et de votre perte de cheveux 2 - 2024

While itching is often caused by dry scalp or dandruff, in more severe cases that include inflammation and painful pustules, scalp folliculitis may be the culprit.

Meet the experts:

  • Dr. Snehal AminMD, is a board-certified dermatologist and co-founder and surgical director of MDCS Dermatology in New York City.
  • Dr. Michelle HenryMD, is a board-certified dermatologist and dermatologist/Mohs surgeon trained at Mount Sinai and Harvard in New York.

Unlike other scalp conditions such as dandruff, scalp folliculitis often requires antibiotic or antiseptic treatment to improve. Some cases of folliculitis may resolve on their own, but others may progress to boils or even cellulitis without treatment.

 Scalp folliculitis and its side effects are intimidating, so we turned to the experts to understand the basics of scalp folliculitis and how to treat it.

What is scalp folliculitis?

Folliculitis of the scalp is a serious inflammatory disorder of the hair follicle which often presents with small, itchy pustules. "It resembles scalp acne and particularly affects the frontal hairline of the scalp.

It can be caused by inflammation associated with ingrown hairs, or infection caused by bacteria, fungi or mites," explains Amin.

Henry adds that it most often causes symptoms such as itching, redness and tender bumps located towards the front of the forehead.

It's also important to note that there are two main types of scalp folliculitis, according to Henry. The first is superficial folliculitis, which is benign and generally easy to treat, Henry explains. The second type is deep folliculitis, which causes deeper infections in the hair follicles and can be more difficult to control.

Signs and symptoms of folliculitis

Scalp folliculitis has the potential to persist or to manifest itself in worse conditions without antibiotic or antiseptic treatment. Left untreated, bacterial folliculitis can evolve into hard, painful, pus-filled masses called boils.

Bacterial folliculitis and boils affect people all over the world, and have a significant negative impact on quality of life. As such, it's important to understand what the signs and symptoms of this condition are in order to seek treatment.

  • Small pruritic lesions: Scalp folliculitis often begins with small, itchy lesions on the front of the scalp. The itching can lead to further pain and infection, as scratching can introduce new bacteria to the now broken skin.
  • Red, inflamed and swollen skin: Scalp folliculitis can also present as red, inflamed and swollen skin. Depending on the size and severity of the infection, it may present as a scalp patch versus an individual pustule.
  • Burning or painful scalp: Henry warns that scalp folliculitis can also cause a burning or painful/tender sensation to the touch.
  • White spots along the hairline: The presence of small white dots along the frontal hairline is one of the clearest indicators of scalp folliculitis, especially in the presence of other symptoms.
  • Deep Pustules: Depending on the type of scalp folliculitis, it may be a progression of the original whiteheads.
  • Hair loss : Although not an initial symptom, Henry warns that if scalp folliculitis becomes severe, it can lead to hair loss. Meeting with a dermatologist to treat scalp folliculitis can help prevent this outcome.

Common causes of scalp folliculitis

Scalp folliculitis is an inflammation of the tiny pockets of our skin from which hair grows (or hair follicles). It occurs when bacteria infect the hair follicle.

According to our two experts, hair follicle inflammation can be caused by certain bacteria, yeasts, fungi and mites. "These include species of micro-organisms known as : Cutibacterium acnes, Staphylococcus aureus, Malassezia species, or else Demodex folliculorum, " explains Henri.

Henry also warns that you're more likely to contract scalp folliculitis if you have a weakened immune system, acne, allergies or dermatitis, or if you're taking medications such as steroid creams.

In addition, those who have already suffered from scalp folliculitis and are looking to prevent its recurrence may want to avoid certain behaviors/holdings.

You should also avoid risk factors for scalp folliculitis, including: shaving too much (especially with dirty razors), whirlpool baths or wearing hats and headbands that trap perspiration near your scalp," explains Henry.

Treating folliculitis: Treatments for folliculitis

The course of treatment for scalp folliculitis can vary according to the cause and severity of each individual case. Without consulting a dermatologist, there are some treatments you can try at home, but our two experts warn that only a dermatologist will be able to determine what you're up against.

Some treatments are simple behavioral changes, while others are prescribed medications.

woman with shompoing on her hair to combat folliculitis
Démangeaison du cuir chevelu : La folliculite pourrait être à l'origine de vos démangeaisons et de votre perte de cheveux 5 - 2024
  • Use an anti-dandruff shampoo: Our two experts recommend that you try washing your scalp and using anti-dandruff shampoos containing antifungal agents. These shampoos are called ketoconazole or ciclopirox and Henry explains that they help eliminate yeast, oil and other microbes around hair follicles, so inflammation and infections are reduced.
  • Choose a natural antiseptic/antifungal: There are several essential oils and plants that are naturally antiseptic or antifungal. Amin recommends tea tree oil as an over-the-counter ingredient to look for when treating scalp folliculitis.
  • Avoid hot water: Scalp folliculitis causes inflammation of the scalp and irritation of the skin barrier. Amin recommends using lukewarm rather than hot water for washing hair, as hot water aggravates itching and causes dry skin. However, he adds that hot compresses after showering are soothing and help drain pustules.
  • Use over-the-counter itch relief: The itchiness of scalp folliculitis can make it tempting to scratch, but this will only exacerbate your problems. Hydrocortisone cream and over-the-counter antihistamines help to relieve the symptoms of itching," shares Amin.
  • Prescribed topical or oral antibiotics/antifungals: Other treatment options include the use of prescription topical antibiotics, such as clindamycin gels or solutions, Henry shares. "Sometimes a steroid lotion or cream may be needed to control inflammation. You can get a prescription for these products from your dermatologist if necessary," she explains. Amin agrees, adding that your dermatologist can prescribe an erythromycin or clindamycin solution or a long-term oral antibiotic tetracycline.

Which products are right for scalp folliculitis?

There are a number of effective remedies available. Topical antimicrobial or antifungal medications are often used to treat mild to moderate infections. These include clotrimazole cream or erythromycin.

If the infection is more severe or recurs, a doctor may recommend an oral antibiotic. From shampoos Medication containing ingredients such as zinc pyrithione, selenium sulfide or ketoconazole can also help manage and prevent scalp folliculitis. Finally, adopting good hair hygiene practices can help reduce the risk of infection.

When should you see a doctor?

Scalp folliculitis can appear gradually and may not seem serious at first, especially if you've already suffered from scalp acne.

However, it's important to seek the advice of a dermatologist, especially if your symptoms persist. "If symptoms don't disappear in a few days with home remedies, you should consult a dermatologist to establish your diagnosis and treatment plan," explains Amin. "Correct diagnosis is important, for example, scalp folliculitis can be confused with other conditions such as scalp psoriasis or acne. 

In addition, there are therapies that are only available by prescription.

Henry agrees and adds, "If you try over-the-counter products for a few weeks (about seven to 10 days) and your symptoms don't improve, see your dermatologist for help."

Scalp folliculitis is an itchy, painful and sometimes severe scalp condition that can lead to serious side effects if left untreated. If you suspect you're suffering from scalp folliculitis, consider trying an anti-dandruff shampoo, but be sure to consult your dermatologist if symptoms persist for more than a week.

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Gabriela is the creator of the blog, a platform dedicated to natural cosmetics and skin care. Her blog is an invaluable source of information and advice on how to achieve perfect, glowing skin. Gabriela passionately shares her in-depth knowledge of natural products, emerging trends and practical tips for an effective skincare routine.

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