From the Guidelines
For folliculitis of the scalp after shaving, start with gentle cleansing using an antibacterial wash containing benzoyl peroxide 2.5-5% or chlorhexidine once or twice daily, as this approach prioritizes reducing morbidity and mortality by preventing infection spread and promoting healing. The treatment of folliculitis involves addressing the infection and reducing inflammation.
- Apply over-the-counter antibiotic ointment like bacitracin or mupirocin to affected areas 2-3 times daily for 7-10 days.
- For more severe cases, topical clindamycin 1% solution or cream twice daily for 10-14 days may be needed, as suggested by general principles of treating skin infections 1. Avoid shaving the affected area until healed and use a new razor when you resume.
- Warm compresses for 10-15 minutes several times daily can help reduce inflammation and promote drainage. If symptoms worsen or don't improve within a week, see a healthcare provider as oral antibiotics like doxycycline 100mg twice daily for 7-10 days might be necessary, considering the potential for complications and the importance of preventing long-term damage to the scalp and hair follicles 1. Folliculitis occurs when hair follicles become infected, typically with Staphylococcus bacteria, which can happen when shaving creates tiny skin injuries that allow bacteria to enter, thus emphasizing the need for careful skin care and hygiene practices to prevent recurrence, as generally recommended for skin and soft tissue infections 1. Given the potential side effects of potent topical steroids, such as folliculitis being a common side-effect of treatment with these agents 1, their use should be approached with caution and considered only when the benefits outweigh the risks, and under the guidance of a healthcare provider.
From the Research
Treatment Options for Folliculitis of the Scalp after Shaving
- The treatment for folliculitis of the scalp after shaving is not directly addressed in the provided studies, but some studies discuss the treatment of folliculitis decalvans, a related condition that leads to scarring alopecia through inflammatory destruction of the hair follicle 2, 3.
- According to these studies, treatment options for folliculitis decalvans include:
- Antibiotics, such as clindamycin and rifampicin, clarithromycin, and dapsone, which have varying success rates and may encourage the development of resistant bacteria 2.
- Oral isotretinoin, which has been shown to be an effective treatment option, with 90% of patients experiencing stable remission during and up to two years after cessation of treatment 2, and 82% of patients healing after treatment 3.
- The use of oral isotretinoin ≥0.4 mg/kg/day for ≥3 months may minimize the likelihood of relapse and is considered a promising treatment alternative for folliculitis decalvans 3.
- Another study found that isotretinoin treatment resulted in a positive clinical and microbiologic response in patients with gram-negative folliculitis, with rapid clearing of the face and nasal mucosa of gram-negative rods and induced prolonged remissions 4.