Folliculitis of scalp

The inflammation of hair follicles in its simplest form appears as a small bump on part of the skin which has hair follicles. Treatment is also based on simple management, with remedies which can be readily made available at home. As the condition of folliculitis has no predilection for age, sex or region, it is one of most common skin ailments. It can appear in any part of the body except the palms of hands, soles of feet and the mucous membrane.

Anatomical location may be widespread at one particular instance as the autogenous extension of folliculitis is very common when personal hygiene is not maintained to good  standards. But even in that case, the morphology of causative or infective organism may differ widely in different locations. The common areas observed to be effected by folliculitis are the facial area with predilection for shaving region, underarms or armpits, scalp, thighs, buttocks and legs, in that order of frequency.

Scalp folliculitis is very common for being most hairy part of body. It is more prone to all kinds of skin infection since it sweats more and being oily it can provide breeding ground for micro-organism who grow on such favorable surroundings. Follicles also get exposed after deep combing allowing invasion of bacteria inside and triggering folliculitis. Like folliculitis in any other location on  skin, scalp inflammation too starts as redness of surrounding skin with appearance of small bump. Two different causes provoke scalp folliculitis. Infectious  folliculitis and non-infectious folliculitis.

The difference in etiology will determine the protocol of treatment. Infectious variant, as name suggests is caused by either one or more of microbes present on skin of scalp or get into from unclean surroundings. It can be effected by bacteria, fungi, parasites or viruses. Non-infectious type is seen in oily scalp.

The  most common and annoying part of  scalp folliculitis is severe itching which can further aggravate an already existing inflammation by damaging more hair.

Treatment of non-infectious scalp folliculitis is based on keeping scalp area as much dry as possible and not letting it get greasy.  Luke warm or cold showers are advisable  instead of hot, as taking showers with hot water will enhance the oily secretion from sebum secreting glands. Salicylic acid or zinc containing shampoos can solve the problem of oily scalp. It is preferable to use these preparation till the scalp folliculitis subsides completely. Local steroidal creams will minimize the annoying symptom of itching.

Infectious scalp folliculitis is commonly caused by staphylococcus aureus, which needs regular wash out with anti-septic soap or lotion,  anti-pruritic steroidal creams, and warm swabs on effected area to clear debris of dead skin in  and around the effected skin.

The choice of anti-biotics to be given orally are either,  cephalexin  or Dicloxacillin or flucloxacillin, dose ranges from 250mg -500mg four times daily for 10 days.

In case of superadded fungal infection, local anti-fungal shampoo baths may suffice. Ketoconazole or econazole are very effective in this regard.

Last but not the least important is alopecia areata, which may occur if complication sets in. Oral or  local injectable steroids can result in re-growth of  lost hair.