Scalp folliculitis could be the cause of your itching and hair loss

Itchy scalp 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. 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.

Unlike other scalp conditions such as dandruff, scalp folliculitis often requires antibiotic or antiseptic treatments 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.

Read on to hear two dermatologists explain the causes and treatment of scalp folliculitis.

What is scalp folliculitis?

Scalp folliculitis is an inflammatory disorder of the hair follicle that 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 an 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 toward 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 mild and usually 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

Folliculitis of the scalp has the potential to persist or get worse without antibiotic or antiseptic treatment. Without treatment, bacterial folliculitis can develop 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 is important to understand what the signs and symptoms of this disease are in order to seek treatment.

• Small pruritic lesions: Folliculitis of the scalp 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, yeast, fungi and mites. "These include species of microorganisms known as : Cutibacterium acnes, Staphylococcus aureus, Malassezia species, or else Demodex folliculorum, " explains Henri.

Henry also warns that you are more likely to develop scalp folliculitis if you have a weakened immune system, acne, allergies or dermatitis, or if you are 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), hot tubs, or wearing hats and headbands that trap sweat near your scalp," Henry explains.

Treatments

The course of treatment for scalp folliculitis can vary depending on 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 are dealing with. Some treatments are simple behavioral changes, while others are prescribed medications.

• Use an anti-dandruff shampoo: Our two experts recommend that you try washing your scalp and using dandruff shampoos that contain antifungal agents. These shampoos are called ketoconazole or ciclopirox and Henry explains that they help eliminate yeast, oil and other microbes around the hair follicles so that inflammation and infections are reduced.
• Choose a natural antiseptic/antifungal: There are several essential oils and herbs 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 warm water rather than hot water to wash your hair, as hot water aggravates itching and causes dry skin. However, he adds that warm compresses after showering are soothing and help drain the 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 are helpful to relieve the symptoms of itching," shares Amin.
• Prescribed topical or oral antibiotics/antifungals: Other treatment options include the use of topical prescription antibiotics, such as clindamycin gels or solutions, Henry shares. "Sometimes a steroid lotion or cream may be needed to control the inflammation. You can get a prescription for these products from your dermatologist if necessary," she explains. Amin agrees and adds that your dermatologist can prescribe an erythromycin or clindamycin solution or a long-term oral antibiotic tetracycline.

When to see a doctor

Scalp folliculitis can develop gradually and may not seem serious at first, especially if you have had scalp acne before. However, it's important to seek the advice of a dermatologist, especially if your symptoms persist. "If symptoms don't go away in a few days with home remedies, you should see a dermatologist to establish your diagnosis and treatment plan," says Amin. "Proper 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."

The take-away meals

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