How Do You Treat Scalp Folliculitis?

Scalp folliculitis is the blockage of hair follicles on the head with bacteria. Scalp creams and shampoos with corticosteroids and antibiotics can help control the condition.

Scalp folliculitis is a disorder that occurs when hair follicles in the scalp become blocked or infected with bacteria. Less commonly, the infection may also be caused by a virus or fungus in the hair follicle. Hair follicles are sacs under the skin where hairs originate.

Symptoms of scalp folliculitis affect the scalp and include:

• Small red bumps that appear like pimples, some with white heads on them
• Bumps may appear in groups
• Bumps may be itchy
• May be painful or tender
• Blisters 
  • May open, ooze, and crust over
• Large areas of red, swollen skin that may leak pus

Scalp folliculitis is considered to be an inflammatory reaction to blockages of hair follicles, and is believed to be caused by: 

• Bacteria (Staphylococcus aureus, Cutibacterium acnes)
• Yeasts (Malassezia species)
• Mites (Demodex folliculorum)
• Skin products
• Hair removal processes such as shaving, waxing, and plucking 
• Ingrown hairs
• Some drugs, such as corticosteroids 
• Tight clothing
• Sticky bandages

Scalp folliculitis is usually diagnosed with a patient history and physical examination. 

Tests that may be indicated to help confirm a diagnosis of scalp folliculitis or to rule out other conditions may include: 

• Gram stain and culture of the contents of a pustule 
• Skin biopsy 

Treatment for scalp folliculitis includes:

• Topical antibiotics 
  • Clindamycin solution
  • Erythromycin solution
• Topical steroid creams or lotions
• Oral antihistamines
• Oral antibiotics, particularly long-term tetracycline
• Oral isotretinoin 
  • Long-term low dose treatment may be required
• Antidandruff shampoos containing antifungal agents such as ketoconazole or ciclopirox may be helpful

Scalp folliculitis may be prevented in some cases. 

• Wash your hands frequently
• Use clean razor blades and replace blades frequently, or use an electric razor or hair removal products (depilatories) instead of shaving or waxing
• Avoid tight-fitting clothing that can irritate the skin
• Avoid use of oily skin products
• Be careful if entering a hot tub – only use hot tubs you know are well-maintained