What are the other Names for this Condition? (Also known as/Synonyms)

• Propionibacterium Folliculitis

What is Scalp Folliculitis? (Definition/Background Information)

• Scalp Folliculitis describes the inflammation of hair follicles on scalp. A hair follicle is a sac that holds the hair root into the skin; the oil glands open into the hair follicle. Any damage to the hair follicles can result in bacterial or fungal infections leading to Scalp Folliculitis
• The contributory factors for Scalp Folliculitis include keeping hair unclean, frequently trying out a variety of hair care products, regularly wearing sports helmets and caps for long periods, acne, and individuals with weakened immunity systems
• Scalp Folliculitis is characterized by the appearance of pus-filled blisters along the hairline, accompanied by severe itching and soreness. Over time, the boils can rupture, bleed, and ooze pus. The skin lesions can lead to scarring and hair loss; the condition can also recur
• The treatment measures for Scalp Folliculitis may include the use of topical applications, oral medications, antibiotics, and cosmetic procedures, if necessary. The prognosis is generally excellent with adequate treatment and self-care

Who gets Scalp Folliculitis? (Age and Sex Distribution)

• Scalp Folliculitis may affect individuals of any age category, but is mostly observed during adulthood
• Both males and females are affected
• Worldwide, individuals of all racial and ethnic background may be affected

What are the Risk Factors for Scalp Folliculitis? (Predisposing Factors)

The risk factors include a variety of conditions that may result in damage to the hair follicles leading to Scalp Folliculitis. These include:

• Having poor hair hygiene including keeping hair unclean, often scratching one’s head, pulling the hair, etc.
• Trying out different hairstyles that impose a tightness on the hair (i.e., tying hair tightly)
• Individuals with coarse or curly hair, especially males
• Shaving the head
• Exposure to unchlorinated waters in community pools and hot tubs
• Keeping the head covered frequently such as wearing tight caps and helmets
• Using several hair shampoos, creams, and lotions; changing hair cosmetic products often
• Presence of acne or other skin infections
• Medications that treat acne may also increase one’s risk for Scalp Folliculitis
• Individuals with poor immunity

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Scalp Folliculitis? (Etiology)

It is believed that Scalp Folliculitis develops as an inflammatory response to certain pathogens in the hair follicles. When the hair follicles are damaged, it gives an opportunity for the pathogenic microorganisms, such as bacteria, yeast, and parasitic mites, to cause an infection.

• The bacterium commonly responsible for Scalp Folliculitis is Cutibacterium acnes; Staphylococcus aureus is responsible for severe forms of this skin condition
• Malassezia (Pityrosporum) yeast species and Demodex folliculorum (mites) are also causative

However, not all cases of Scalp Folliculitis are caused by infectious agents. The other causes may include:

• Ingrown hairs
• Poor hygiene
• Use of topical antibiotics for prolonged periods
• Individuals with an immunocompromised health status

What are the Signs and Symptoms of Scalp Folliculitis?

The signs and symptoms of Scalp Folliculitis may vary from one individual to another and may be mild or severe. The signs and symptoms may include:

• Formation of small-sized (white-tipped) pustules on the scalp, due to inflammation of the hair-follicles
• The skin around the region is tender and present a reddish discoloration
• These lesions, which are mostly seen along the frontal hairline, are very itchy
• Some cases are mild, with the presence of a few lesions; sometimes, they may be numerous
• Individuals may feel pain and burning sensation
• The pus-filled blisters may turn sore and crusty (yellow scabs)
• From the front, the condition may move to the center and back of the head
• The blisters can rupture and discharge pus; the hair around the lesion may clump together due to the discharge

How is Scalp Folliculitis Diagnosed?

A diagnosis of Scalp Folliculitis may involve the following:

• Physical examination and a complete medical history; a dermatologist will visually examine the lesions to help in the diagnosis
• Blood tests, analysis of pus, culture of the fluid being drained, as needed
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Scalp Folliculitis?

Scalp Folliculitis can cause the following complications:

• Emotional and psychological stress
• Secondary bacterial and fungal skin infections, which may result in fever and other associated signs and symptoms
• Scarring of the affected scalp region leading to cosmetic issues
• Patches of hair loss, which may be permanent
• The infection may spread to other skin sites (termed cellulitis)
• Scalp Folliculitis may recur after completion of treatment

How is Scalp Folliculitis Treated?

The treatment of Scalp Folliculitis may involve the following measures:

• Use of topical antibiotic creams
• Application of steroidal lotions and ointments
• Administration of oral medications such as antihistamines and isotretinoin
• Medications, such as antibiotics (doxycycline), may be used for bacterial infection
• Phototherapy
• Hair removal through laser application
• Minor surgery to drain pus from the lesions, if necessary

Self-care (home) remedies may include:

• Wash the lesions with mild antibacterial soap
• Wash hair regularly using a mild shampoo (anti-dandruff and anti-fungal) with conditioner, if needed
• Apply warm compress
• Use lukewarm water, and not hot water, to wash hair
• Wash hands before applying topical applications
• Keep nails trimmed; do not pick at the scalp lesions
• Avoid shaving the head for a period of time
• Use a new razor each time for shaving hair

How can Scalp Folliculitis be Prevented?

Scalp Folliculitis may be prevented by considering the following measures:

• Maintain good hair and body hygiene
• Minimize wearing of helmets, caps, and hats
• Avoid switching cosmetic hair care products often
• Take appropriate treatment for acne and dermatitis
• Do not use old and dull razors
• Avoid exposure to untreated swimming pools and hot tubs

What is the Prognosis of Scalp Folliculitis? (Outcomes/Resolutions)

• The prognosis of Scalp Folliculitis is typically excellent, since the condition can be managed easily with adequate treatments
• With suitable treatment and self-care measures, an improvement in the condition can be seen within a few days

Additional and Relevant Useful Information for Scalp Folliculitis:

Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition.