Folliculitis and Its Impact on Hair
Folliculitis is an inflammatory reaction in the hair follicles that can lead to hair loss when severe or recurrent, particularly when it affects the scalp. 1
Definition and Pathophysiology
Folliculitis is an inflammatory condition affecting the hair follicles, characterized by:
- Inflammation of the superficial aspect of hair follicles
- Development of small (1mm) vesicles, pustules, or papulopustules in acute cases
- Hyperkeratosis and keratotic plug formation in chronic cases 1
The condition can involve different parts of the hair follicle:
- Infundibulum (superficial part)
- Isthmus (middle section)
- Inferior segment (stem and hair bulb) 1
Types and Causes
Folliculitis can be classified into two main categories:
1. Infectious Folliculitis
- Bacterial: Most commonly caused by Staphylococcus aureus (18% of cases) 2
- Fungal: Seen in approximately 8% of cases 2, including Candida species 3
- Viral: Less common but can occur
2. Non-infectious Folliculitis
- Mechanical irritation (shaving, friction)
- Chemical irritation
- Inflammatory conditions
Clinical Presentation
Folliculitis typically presents as:
- Small pustules or papules centered around hair follicles
- Redness and inflammation surrounding the follicles
- Itching or mild pain
- When affecting the scalp, may cause patchy alopecia with scattered pustules 4
In more severe cases, folliculitis can progress to:
- Furuncles (boils): Deeper infection of a single follicle extending into dermis
- Carbuncles: Coalescent inflammatory mass with pus draining from multiple follicular orifices 4
Impact on Hair
When folliculitis affects the scalp, it can:
- Cause temporary hair loss in affected areas
- Lead to diffuse, patchy alopecia coexisting with scattered pustules 4
- In severe cases (like folliculitis decalvans), cause permanent scarring and hair loss 5
- Disrupt normal hair growth cycle due to inflammation
Diagnosis
Diagnosis is primarily clinical but may include:
- Visual examination of characteristic follicular-based pustules
- Culture of pustular material to identify causative organisms
- In unclear cases, skin biopsy with histopathologic examination 5
Treatment
For Simple Folliculitis:
- Topical benzoyl peroxide is a first-line nonantibiotic treatment 6
- Topical antibiotics like mupirocin or clindamycin for bacterial folliculitis 6
- Antifungal treatments for fungal folliculitis (e.g., clotrimazole) 3
- Warm compresses to promote drainage 7
For Severe or Recurrent Cases:
- Oral antibiotics (cephalexin or dicloxacillin) for treatment-resistant bacterial folliculitis 6
- Incision and drainage for large furuncles or carbuncles 7
- For recurrent folliculitis/furunculosis:
Prevention of Recurrence
To prevent recurrent folliculitis:
- Improve personal hygiene with antibacterial soaps like chlorhexidine 7
- Avoid sharing personal items like towels and razors
- Use proper shaving techniques with adequate lubrication 4
- Avoid tight clothing that causes friction
- For those with nasal S. aureus colonization, application of mupirocin ointment twice daily for the first 5 days each month reduces recurrences by approximately 50% 7
Special Considerations
Pubic Folliculitis
- Common after shaving pubic hair
- Counsel patients that shaving should be performed carefully with adequate lubrication to minimize trauma 4
Scalp Folliculitis
- May require specialized treatment to prevent hair loss
- Consider evaluation for underlying conditions if recurrent or severe 5
When to Seek Medical Attention
Medical evaluation is recommended for:
- Folliculitis that doesn't improve with home treatment
- Spreading infection or worsening symptoms
- Recurrent episodes of folliculitis
- Development of fever or systemic symptoms
- Folliculitis in immunocompromised individuals
Early and appropriate treatment of folliculitis is essential to prevent complications and minimize the impact on hair growth and health.