From the Guidelines
Treating scalp folliculitis requires a gentle and targeted approach to reduce inflammation, prevent infection, and promote healing, with the most effective treatment often involving the use of gentle, antibacterial shampoos containing ingredients like ketoconazole, as recommended in the provided evidence 1. To manage scalp folliculitis effectively, it's crucial to keep the scalp clean and reduce the risk of further irritation.
- Use gentle, antibacterial shampoos that contain ingredients such as ketoconazole, selenium sulfide, or pyrithione zinc, as these have been shown to be effective in reducing the risk of scalp folliculitis 1.
- Wash your hair daily until symptoms improve, then reduce to 2-3 times weekly for maintenance.
- For mild cases, apply warm compresses to the affected areas for 15-20 minutes several times daily to reduce inflammation and promote drainage.
- Over-the-counter topical antibiotics like bacitracin or neomycin can be applied directly to lesions for additional treatment.
- For moderate to severe cases, it's essential to consult a healthcare provider, who may prescribe oral antibiotics such as doxycycline (100mg twice daily for 7-14 days), clindamycin, or cephalexin, based on the severity of the condition and the presence of any secondary infections 1.
- Topical prescription treatments might include clindamycin lotion or mupirocin ointment applied twice daily for 7-10 days.
- Antifungal medications may be prescribed if the folliculitis is fungal in nature.
- It's also important to avoid scratching, sharing personal items like combs or hats, and using harsh hair products during treatment, as these can exacerbate the condition and lead to further complications 1.
- Proper hygiene and avoiding irritants are essential for both treatment and prevention of recurrence, as folliculitis occurs when hair follicles become infected with bacteria (commonly Staphylococcus aureus), fungi, or become irritated.
From the Research
Treatment Options for Scalp Folliculitis
- The treatment of scalp folliculitis depends on the underlying cause, which can be infectious or non-infectious 2.
- For infectious folliculitis, antibiotics may be used to treat bacterial infections, while antifungal medications may be used to treat fungal infections 3, 4.
- In the case of folliculitis decalvans, a rare form of primary neutrophilic cicatricial alopecia, oral fusidic acid has been shown to be effective in treating the condition 5.
- Topical treatments such as betamethasone dipropionate, salicylic acid, and azelaic acid may also be used to reduce inflammation and promote hair regrowth 5.
- For eosinophilic pustular folliculitis, an accurate diagnosis is essential to avoid unnecessary therapies, as the condition is benign and self-limiting 6.
Medications Used to Treat Scalp Folliculitis
- Fusidic acid: an anti-staphylococcal drug with few adverse effects, used to treat folliculitis decalvans 5.
- Fluconazole: an antifungal medication used to treat fungal infections such as folliculitis barbae candidomycetica 3, 4.
- Itraconazole and ketoconazole: antifungal medications used to treat fungal infections such as folliculitis barbae candidomycetica 3.
- Tetracyclines and clindamycin with rifampicin: antibiotics used to treat bacterial infections such as folliculitis decalvans 5.
Important Considerations
- The diagnosis of folliculitis occasionally requires histologic confirmation and cannot be based solely on clinical appearance of scalp lesions 2.
- The treatment of scalp folliculitis should be tailored to the individual patient and the underlying cause of the condition 2, 5.
- It is essential to avoid unnecessary therapies and to use medications that are effective and have few adverse effects 5, 6.