How to treat scalp folliculitis, a common skin condition that causes acne-like sores on your scalp

• Scalp folliculitis is a skin rash that can be caused by bacteria, fungi, viruses, or mites.
• Mild cases often clear up on their own, but your symptoms may sometimes get worse without treatment.

You have over one million hair follicles on your head. These thin tube-like structures help your hair grow.

But if your hair follicles become inflamed or infected, you can develop an uncomfortable, itchy rash known as scalp folliculitis.

Folliculitis is common and can happen anywhere hair grows on your body, not just on your scalp. Shaving often causes folliculitis on your face or legs, for instance. And if you've ever had itchy bumps on your skin after using a hot tub, you likely contracted "hot tub folliculitis."

Many cases of scalp folliculitis are mild and will clear up with a little at-home care. However, moderate to severe folliculitis that goes untreated may lead to scarring or permanent hair loss.

Read on to learn the causes and symptoms of scalp folliculitis and when to consult a doctor, along with some tips for treating and preventing this condition.

Symptoms

If you have scalp folliculitis, you'll typically notice small, itchy sores on your scalp, most often on your frontal hairline. You could have a small cluster of sores or — in more severe cases — many sores over a large area of your scalp.

The sores resemble acne, but they also tend to cause:

• Itching or burning sensations
• Painful and tender skin
• Blisters filled with pus
• Crusting of your skin when the blisters break

In mild folliculitis cases, you'll have slight discomfort, itching, and just a few sores. Moderate to severe folliculitis causes more painful sores that can spread over your scalp. With proper treatment, though, most cases of folliculitis will resolve within a few days to a few weeks, says Dr. Alpana Mohta, dermatologist and medical advisor for Better Goods.

However, your symptoms can persist for several months or longer if you don't treat the underlying cause, Mohta says.

Note: Folliculitis decalvans — a rare type of folliculitis — causes ongoing inflammation in your scalp that leads to permanent hair loss and scarring. It mostly affects men between the ages of 40-60. There's no cure for this condition, though treatment can reduce scarring and hair loss.

Causes

Bacteria, especially Staphylococcus aureus, cause most cases of scalp folliculitis. Less common causes include:

• Fungi
• Viruses like herpes
• Mites

Mohta says the following factors can increase your risk of developing scalp folliculitis:

• Wearing tight items on your head like hats, headbands, or helmets
• Not washing your hair and face
• Wearing hairstyles that pull at your skin, like ponytails or tight braids
• Excessive sweating
• Spending time in hot or humid environments like a hot tub or sauna
• Underlying medical conditions such as diabetes or immunodeficiency disorders
• Long-term use of oral antibiotics

Diagnosis

According to Dr. Alain Michon, medical director at Ottawa Skin Clinic, you should make an appointment with a doctor as soon as possible if:

• You have sores on your scalp that are discolored, pus-filled, and painful.
• You develop a fever or other signs of infection, such as swelling or warmth of your skin.

It's also a good idea to check in with a healthcare professional if you have mild symptoms of folliculitis that don't improve after a week or two.

"Most of the time, scalp folliculitis can be identified simply through visible signs and symptoms," Michon says.

Note: A primary care doctor can usually diagnose and treat scalp folliculitis, but they may refer you to a dermatologist if you have more severe or persistent symptoms.

In some cases, your doctor or clinician may recommend tests to identify the cause of infection or rule out other possibilities. For example, they may:

• Scrape your skin to check for yeast using a microscope.
• Take a skin swab to find the cause of your infection.
• Perform a skin biopsy to rule out other conditions.

Treatment

Mild folliculitis will often go away on its own or heal in a few days with home remedies and over-the-counter (OTC) medications.

For mild folliculitis, Michon recommends:

• Using shampoo and conditioner on your hair daily: It may help to choose a shampoo made for sensitive skin to avoid further irritating your scalp.
• Applying over-the-counter anti-itch creams: Hydrocortisone can help relieve itching and reduce inflammation. You can also try an OTC antibiotic, like Neosporin.
• Rinsing your hair with warm water before bed: This helps remove any dirt or debris that may further irritate your scalp.
• Applying warm towels to the irritated areas of your scalp: This can help reduce pain and swelling.

If you have moderate to severe folliculitis, Michon recommends getting treatment as soon as possible to prevent scarring and hair loss.

Treatment for scalp folliculitis tends to depend on the underlying cause, but your doctor may recommend one or a combination of these treatments:

• Topical antibiotics like mupirocin and clindamycin, or oral antibiotics for severe cases
• Topical or oral antifungals like itraconazole and fluconazole
• Medicated shampoo
• Antivirals, like acyclovir, valacyclovir, and famciclovir
• Antiparasitics, like permethrin lotion or oral ivermectin or metronidazole

Your skin discoloration may take a while to fully disappear, but in most cases, treatment will eventually resolve all your symptoms, Michon says.

There's a chance your scalp folliculitis could return, but you can take a few steps to help lower the risk of a recurrence, including:

• Washing your hair and face regularly.
• Loosen anything you wear on your head, like hats or headbands. When possible, avoid wearing them entirely.
• Avoid hot tubs and pools, or choose ones you know are clean. Shower with soap and wash your hair afterwards.

Insider's takeaway

Scalp folliculitis is a common condition. Most cases are minor and treatable at home by cleaning your hair and scalp and applying OTC medications.

Severe cases of scalp folliculitis, however, usually need medical treatment, so it's best to connect with a doctor if you have painful sores with pus, develop a fever, or have symptoms that last more than a week.

Your doctor can help identify the cause of your scalp folliculitis and recommend an effective treatment to ease uncomfortable symptoms and prevent scarring or hair loss.