From the Guidelines
The best treatment for scalp folliculitis typically involves a combination of topical and oral medications, with a focus on maintaining good scalp hygiene and avoiding potential triggers. For mild cases, start with topical antibiotics like clindamycin 1% solution or benzoyl peroxide 2.5-5% wash applied to the affected areas once or twice daily for 7-14 days 1. Some key points to consider when treating scalp folliculitis include:
- For moderate to severe cases, oral antibiotics are recommended, such as doxycycline 100mg twice daily or cephalexin 500mg four times daily for 7-14 days 1
- Antifungal treatments may be necessary if the folliculitis is fungal in nature, with ketoconazole 2% shampoo used 2-3 times weekly or fluconazole 150mg orally once weekly for 2-4 weeks being effective options
- Maintaining good scalp hygiene is crucial - wash hair regularly with gentle, antibacterial shampoos and avoid sharing hair care items
- Warm compresses can help drain pustules and reduce inflammation
- For recurrent cases, consider longer treatment courses or maintenance therapy, and identify potential triggers such as occlusive hair products, excessive sweating, or underlying conditions like diabetes that may contribute to recurrence It's also important to note that folliculitis can be a side-effect of treatment with potent topical steroids, as seen in the treatment of alopecia areata 1. However, the most recent and highest quality study on the treatment of skin and soft tissue infections, including folliculitis, recommends treating the infection based on the causative organism and severity of the infection 1.
From the Research
Treatment Options for Scalp Folliculitis
- The treatment of scalp folliculitis can involve various approaches, including antibiotics, antiseptics, and oral medications 2, 3, 4.
- A study published in 2019 reported the successful treatment of folliculitis decalvans with oral fusidic acid 2.
- Another study published in 2021 compared the effects of different interventions, including topical antibiotics, topical antiseptics, systemic antibiotics, phototherapy, and incision and drainage, for people with bacterial folliculitis and boils 3.
- Oral isotretinoin has been shown to be an effective treatment for folliculitis decalvans, with a success rate of 90% in achieving stable remission 4.
Comparison of Treatment Regimens
- A retrospective study compared the efficacy of different treatment regimens, including clindamycin and rifampicin, clarithromycin, dapsone, and isotretinoin, in 28 patients with folliculitis decalvans 4.
- The study found that treatment with isotretinoin was the most successful oral treatment, with 90% of patients experiencing stable remission during and up to two years after cessation of treatment 4.
- Another study published in 2023 described a practical algorithm for the management of superficial folliculitis of the scalp, based on 10 years of clinical and dermoscopy experience 5.
Classification and Diagnosis
- Superficial folliculitis of the scalp can be caused by various factors, including infectious agents, inflammatory conditions, and other underlying scarring disorders 5, 6.
- A review published in 2004 described the different types of folliculitis based on their etiology, clinical manifestation, and treatment 6.
- Accurate diagnosis and classification of folliculitis are essential to prevent poorer outcomes and to guide appropriate treatment 5, 6.