Understand Scalp Folliculitis - Causes, Symptoms & Solutions

We all know of Acne. And Pimples. A big enemy to our faces. Especially during puberty! Now, did you know that you could get acne on your scalp? Yes. Scalp Acne exists. It is a form of Folliculitis, a condition that is more common than one would think! If you look the term up, Google will tell you that there are more than 10 million people affected by this per year (India). It affects your scalp a great extent, can lead to hair loss and it can be a very painful experience. It not just affects you physically but also psychologically as you struggle with it. Just as the acne on your face! Since not many are aware of this condition for what it is or deduce it to be something which is an extension of pimples or acne, it is unfortunately ignored or attended to with ‘home remedies’ until it’s very late. By waiting, or trying out things on your own to seemingly treat it, you may be aggravating your condition without realising it. You may be using a product that is reacting negatively with your scalp...You may be scrubbing/scratching your scalp more than you should, while washing or otherwise, making things worse... You may be showering with hot water wanting to soothe the discomfort, but in truth worsening the condition as anything more than warm is not advised… And so on. As we always say, awareness is the key to tackling a problem head-on, in a timely manner. And today, we are breaking this specific condition down for you, to understand it easily. We will also explain the recommended scalp acne treatment. What is Scalp Folliculitis? Folliculitis refers to the inflammation and infection of the skin around one or more hair follicles. Hair follicles, as you may be aware, are the pockets of opening from which your hair shaft grows out. They are the roots of your hair. Do read our blog on hair anatomy for better understanding. Scalp Folliculitis is an inflammatory condition of the scalp in which the hair follicles get inflamed following an infection. Clinically it is defined as the presence of inflammatory cells within the wall and ostia of the hair follicle, creating a follicular-based pustule. The microorganisms causing Scalp Folliculitis infection include bacteria like staphylococcus aureus and pseudomonas, or fungi like Dermatophytes and Pityrosporum folliculate, and viruses like molluscum contangiosum and herpes simplex. The inflamed scalp hair follicles present as small pustules that appear like acne or pimple with a white head and hence the common reference - scalp acne. The inflamed follicles get very itchy and painful. It is often associated with acne and it also responds to the therapy used for the treatment of acne vulgaris. The acne-causing bacteria Propionibacterium acnes is also thought to be responsible for causing infection and inflammation of the scalp hair follicle. It is thus known to be more common in those who are prone to acne. Further, also in those who regularly use topical steroid creams. Scalp Folliculitis gets very troublesome and also embarrassing, especially when the red pustules appear on the frontal hairline. When not attended to immediately, it can become a severe infection, causing permanent hair loss and scarring. Very rarely does the condition, even when mild, resolve on its own. You need a professional to diagnosis this right for you. A trichologist can perhaps spot the condition by just looking at your scalp, while you are busy scratching your head (quite literally here!) wondering about what it could be! What are the commonly known Scalp Folliculitis causes? While the exact etiology and scalp acne causes are not specifically known, experts believe that Scalp Folliculitis is caused due to inflammation of hair follicles mainly following microbial infection. It is usually caused by a fungal or bacterial infection that occurs when you damage your hair follicles. Viruses, bacteria, yeast or fungi, mites are the usual suspects. Although infection is the main cause of Scalp Folliculitis, other factors that irritate the scalp skin are likely to increase the chances of hair follicle infection. The other external factors that could increase the risk of this condition include,

• Excessive use of hair cosmetics such as hair oils, styling products, shampoos, etc. that could irritate the skin of the scalp and cause inflammation.
• Using public swimming pools or sharing other hygiene items that are not clean.
• Having an injury such as cuts or bruises on the scalp which could get infected and further spread to hair follicles.
• Illnesses that lower the immune power of the body. E.g. Cancer or HIV infection.
• Autoimmunity disorders trigger Folliculitis Decalvans leading to Scarring alopecia.

The condition could affect anyone. However, there are some risk factors that can make one more prone to it than others. Also, it can be observed in any part of the body, but since the scalp has the maximum number of hair follicles, it is the most common site for Folliculitis. Following are some risk factors that can aggravate Scalp Folliculitis:

• Having acne breakouts
• Male gender
• Having thick and curly hair especially, in men
• Weakened immunity system
• Wearing tight caps or scarves that increase sweating on the scalp, for instance, wearing helmets for a long time
• Inflammation of the scalp skin and hair follicles, occurring due to frequent shaving
• consuming certain medications for acne, including steroid creams or antibiotic therapy

Considering the position of these pimples, you may not be able to quite see them as is. You may be only feeling it, and experiencing the discomfort. Your trichologist can help diagnose the problem by getting a proper view of the scalp through capilloscopy, and also identify the triggers for you. What are the common symptoms? Some of the typical Scalp Folliculitis symptoms include,

• Clusters of red bumps that look like pimples near the hair roots
• Pus-filled blisters around hair follicles
• Sores with yellow/brown scabs
• Itchiness and constant scratching on the scalp skin
• Loss of hair in a severe form of Scalp Folliculitis
• Formation of crusts on the red pustules
• Burning or stinging sensation, pain or tenderness
• Receding hairline especially when the pustules are formed along the hairline
• Rupture of pustules casing abscess in severe deep Scalp Folliculitis

Some of these symptoms can overlap with other scalp infections/ conditions, along with other factors. A correct diagnosis can be drawn only by a Trichologist, a trained professional who understands all things ‘hair and scalp’! The diagnosis of the condition rolls out as below:

• A careful examination of the scalp and hair.
• The trichologist examines the appearance of red spots and pustules at the base of the hair.
• Your medical history is reviewed to find out if there are any other underlying conditions that could be causing infections to the hair follicles.
• Trichologist may perform dermoscopy of the scalp, which is a microscopic examination of scalp skin.
• A sample of infected skin and hair is taken to perform a swab test. This helps to identify the microorganism responsible for causing infection of hair follicles.
• In very rare cases, some skin may be scraped off to send the sample for biopsy testing. This helps to rule out the possibility of other diseases of the scalp and also confirms the diagnosis of Scalp Folliculitis.

The clear understanding of the severity of the condition, physical and clinical examination, identifying the root cause, and understanding the lifestyle of the individual, will help the Trichologist in addressing it with the most appropriate treatment. A consultation is thus very crucial to addressing the problem right. Can Scalp Folliculitis be cured? What are the possible solutions? Yes. Scalp Folliculitis can be cured, when attended to professionally without delay. Scalp Folliculitis solution or scalp acne treatment depends upon the severity of the condition. Since it is mainly caused due to microbial infection, medications to cure the infection become necessary. Other treatments such as surgery or laser hair removal may be needed in some cases. In most cases topical antibacterial or antifungals in the form of lotions, creams, sprays or shampoos are prescribed to control the infections. Ingredients such as salicylic acid, glycolic acid, ketoconazole or ciclopirox, tea tree oil, and jojoba oil have been observed to be helpful as scalp acne remedies. The common antimicrobial agents include tetracycline, fusidic acid gel, erythromycin solution. Staphylococcus is the most common causative organism, hence anti-staphylococcal agents such as mupirocin or retapamulin ointment; topical clindamycin solution/lotion may be prescribed by the trichologist after personal consultation. Oral medication is mostly avoided. This apart, you will also be advised on a suitable hair care regimen and the products that would suit your condition best. It all boils down to getting a timely, accurate diagnosis, as most of the symptoms overlap with many other scalp conditions. It thus needs to be effectively treated, with professional intervention. How can scalp acne be prevented? Here are some basic tips to help prevent the condition,

• Avoid wearing tight caps, hats, scarfs, or other materials to avoid friction on the scalp
• While shaving your scalp hair make sure not to shave too closely
• While using public swimming pools, take a thorough shampoo wash once out from the pool
• Avoid pulling your hair into tight ponytails or braids
• Wash your hair regularly with a mild shampoo
• Avoid excessive use of hair styling products
• Avoid sharing hygiene items such as comb, hairbrushes, towels, etc.
• Clean hairbrushes and comb thoroughly after using

Self-diagnosis and medication is definitely not something that we would advise for tackling this condition. Trichologists will not just prescribe you medicines and treatments, but also advise on dos and don'ts as regards your lifestyle, routine habits & very importantly, your diet. In case the condition is due to specific irritants/allergens that are causing the hair follicles to be affected, the hair doctor will also help you isolate and stay clear of those. We would also suggest that a half-yearly Trichology Check is made a part of your calendar, just as your annual general check-up, to keep a tab on the hair and scalp condition, and stay clear of concerns. Do read our pages with more information on the discussed topics and reach out to us for any further clarifications or simply for a chat with our experts! Remember for all things ‘Hair’, do follow our blogs on hair loss, hair care, laser hair reduction, treatments and solutions, and such other interesting hair trivia! Connect with us on social media on the links below. Do leave your questions & comments and we will address them all. Instagram Facebook Youtube