From the Guidelines
Scalp folliculitis should be treated with antimicrobial shampoos and warm compresses as first-line therapy, with topical or oral antibiotics reserved for moderate to severe cases. This approach prioritizes minimizing the risk of antibiotic resistance and reducing the potential for side effects associated with antibiotic use 1.
Treatment Options
- For mild cases, over-the-counter antimicrobial shampoos containing ketoconazole 1% (like Nizoral), selenium sulfide, or pyrithione zinc can be used daily for 1-2 weeks.
- Apply warm compresses to the affected areas for 15-20 minutes several times daily to reduce inflammation and promote drainage.
- For moderate cases, topical antibiotics like clindamycin 1% solution applied twice daily for 7-10 days may be necessary.
- Severe or persistent cases require oral antibiotics such as doxycycline 100mg twice daily for 7-14 days or cephalexin 500mg four times daily for 7-10 days.
Prevention and Hygiene
- Avoid scratching, using harsh hair products, and wearing tight headgear that can trap sweat and bacteria.
- Maintain good hygiene by washing your scalp regularly, changing pillowcases frequently, and avoiding sharing hair tools.
- Folliculitis occurs when bacteria (commonly Staphylococcus aureus), fungi, or other microorganisms invade damaged hair follicles, with risk factors including excessive sweating, certain medications, and compromised immune systems.
Monitoring and Follow-up
- If symptoms worsen or don't improve within two weeks of treatment, consult a healthcare provider for further evaluation.
- It's essential to note that potent topical steroids, which may be used for other scalp conditions like alopecia areata, can cause folliculitis as a side effect 1.
From the FDA Drug Label
DOSAGE & ADMINISTRATION SECTION Cutaneous candidiasis, tinea corporis, tinea cruris, tinea pedis and tinea (pityriasis) versicolor: It is recommended that Ketoconazole Cream 2% be applied once daily to cover the affected and immediate surrounding area Seborrheic dermatitis: Ketoconazole Cream 2% should be applied to the affected area twice daily for four weeks or until clinical clearing.
The treatment for seborrheic dermatitis which can be associated with scalp folliculitis is applying Ketoconazole Cream 2% twice daily for four weeks or until clinical clearing 2.
From the Research
Scalp Folliculitis Overview
- Scalp folliculitis is a condition characterized by inflammation of the hair follicles on the scalp, which can be caused by bacterial, fungal, or viral infections, as well as inflammatory conditions 3, 4, 5.
- The condition can lead to scarring alopecia, particularly in cases of folliculitis decalvans, where the inflammation destroys the hair follicle 6, 7.
Treatment Options
- Oral isotretinoin has been shown to be an effective treatment for folliculitis decalvans, with a high success rate in achieving long-term remission 6, 7.
- Antibiotics, such as clindamycin and rifampicin, are commonly used to treat bacterial folliculitis, but may have a high relapse rate and contribute to the development of resistant bacteria 3, 6.
- Antifungal treatment has been shown to be effective in reducing symptoms in patients with nonscarring scalp folliculitis, particularly in cases where Malassezia is detected 4.
- A practical algorithm for the management of superficial folliculitis of the scalp has been proposed, which involves differentiating between infectious and inflammatory causes and using a combination of clinical, dermoscopic, and histopathological features to reach a proper diagnosis 5.
Causes and Characteristics
- Malassezia has been identified as a potential cause of nonscarring scalp folliculitis, and immunosuppression may serve as a predisposing factor in a subset of patients 4.
- Bacterial infections, such as Staphylococcus aureus, can also cause scalp folliculitis, particularly in cases of folliculitis decalvans 3, 6.
- Inflammatory conditions, such as rosacea and acneiform eruption, can also present as scalp folliculitis and must be differentiated from other underlying scarring disorders 5.