Eczema is a widespread condition, present in 20% of patients seeking medical care for dermatological problems [1]. But there are many kinds of eczema out there, some better known than others. Follicular eczema is a minor and lesser-known form of atopic dermatitis, despite it being fairly common [2]. It can affect the hair follicles on your limbs, trunk, or more rarely, your scalp or face. This article will tell you all you need to know about this condition, such as:
Follicular eczema is a minor, less scientifically discussed form of atopic dermatitis. Atopic dermatitis affects 20% of children and 10% of adults worldwide [3], but it is unclear how many of them experience follicular eczema.
This condition is believed to affect more children than adults, especially those with darker skin tones (which can also make it easier to miss) [2][4]. For example, researchers found it to be the 4th most common follicular disorder among the paediatric population of India [2].While atopic dermatitis manifests on entire patches of skin, follicular eczema only affects the hair follicles in a certain area on your scalp or body. This is why you may notice a specific goosebump appearance on a patch of your skin if you have this condition [2].
The key symptom of follicular eczema is rough goosebumps on the affected patches of skin. That effect is caused by small, skin-coloured bumps that form around the hair shafts, at the opening of the hair follicles. Sometimes, they can be red and inflamed, but not necessarily.
The skin in the affected areas is often dry and sometimes scaly, which is why itchiness is one of the main symptoms associated with this condition.
Follicular eczema mainly affects the limbs, trunk, nape, and the inside of the knees and elbows [2][5]. It is less common for the scalp or face to be affected by this condition [2].
Since follicular eczema is a type of atopic dermatitis, its causes are not fully understood. However, it is believed to be genetically inherited and triggered by environmental factors, such as [1]:
People who inherit this condition generally have dysfunctions of their skin barrier, which allow more allergens through, triggering the body’s immune response [6]. Moreover, having atopic dermatitis of any kind increases your chances of also developing allergic rhinitis and asthma [7].
For some people, childhood follicular eczema will resolve itself in the teenage years. However, if you still have it or develop it as an adult, you are likely to have this condition forever. But fortunately, this condition does not produce symptoms permanently. It flares up when triggered by internal factors (e.g. hormonal changes, stress) or external influences (e.g. cold weather, allergens).
People experience eczema flares differently. For some they may last a few days, while others may have symptoms for weeks. Normally, a follicular eczema flare-up lasts about 1-3 weeks before subsiding [2].
The treatment for follicular eczema is generally the same as for other forms of atopic dermatitis: keeping the affected skin clean and moisturised and if needed, taking over-the-counter antihistamines to alleviate the itching. Low-potency steroid creams are not usually recommended, as this condition has been found to respond poorly to them [8].
However, if the flare-up is severe and on extended portions of your body, your dermatologist may recommend a 2-4 week treatment course with mid-to-high potency topical corticosteroids, which can be effective against follicular eczema [5][9].
There is nothing you can do to prevent the development of follicular eczema, but there are some steps you can take to reduce flare-up frequency once you’ve got it. Knowing and avoiding your triggers is the best way to keep them at bay. For example, wearing long sleeves and gloves in cool weather may help if you have a history of follicular eczema on your arms from the cold.
Keeping your skin moisturised at all times and your stress levels under control can also be beneficial.
Several conditions can affect your hair follicles with presentations that may resemble follicular eczema. Here are some of the most common [8][9]:
Contact (allergic) dermatitis occurs when your skin is exposed to a substance you are sensitive or allergic to and has an inflammatory reaction. A specific form of this condition — follicular contact dermatitis — is very similar to follicular eczema.
Follicular contact dermatitis involves developing small fluid-filled blisters (papules) around your hair follicles. They can be accompanied by redness, swelling and inflammation and will normally cause itching, pain and burning [10].
While this isn’t always the case, follicular contact dermatitis symptoms are often more intense than those of follicular eczema and the papules are redder and larger.
Folliculitis is a condition that occurs when your hair follicles become infected by bacteria, viruses or fungi [11]. You can develop it on any hair-covered part of your body, including your face and scalp (scalp folliculitis). Folliculitis causes small, inflamed bumps or pimples to form around your hair roots and it is usually accompanied by redness, inflammation, itching and pain.
Unlike folliculitis, follicular eczema is not an infection, so it should not present with pus-filled pimples or thick, yellow crusts.
Some types of drugs, such as certain kinds of heart medications, antibiotics, cancer treatments or antidiuretics [12] can cause rashes on some patients’ skin as a side effect. These rashes can look like eczema, with reddish raised bumps, inflammation, swelling and itching. However, they are usually not localized around the hair follicles, but rather randomly distributed across a patch of skin.
Normally, follicular eczema flare-ups are mild and will subside with home care. However, if you have major discomfort, the affected area is large, or there are signs of a secondary infection, you may need medical attention.
Be on the lookout for symptoms that get worse instead of better, such as increased redness, inflammation and pain, or pus forming around the follicles.
A dermatologist will often be able to recognise follicular eczema simply by closely examining the affected area and performing a dermoscopy. However, if the presentation is atypical or they have reason to suspect a different condition, your doctor may also request a skin biopsy. This means a small sample of your skin will be extracted and sent to the laboratory for analysis. If you have follicular eczema, your biopsy should reveal characteristic fluid buildup within your hair follicles (spongiosis) [5].
The face or scalp are less common sites for follicular eczema to manifest [2]. However, even in the rare cases when they do, face and scalp eczema does not normally cause hair loss in adults [13], so neither should follicular eczema. It would take a severe form with major inflammation to cause your hair to fall out. There are no scientific reports of patients experiencing hair shedding because of this specific condition.
If you have follicular eczema on your scalp and face, avoid scratching the area, as it can lead to hair breakage. Keeping your scalp well-moisturised will not only help your symptoms, it will also help prevent dry, brittle hair that may break more easily.
If you are experiencing a rash of any kind on your scalp, it is natural to be concerned. While follicular eczema may not cause hair loss, other conditions with a similar presentation might, so it is a good idea to get an accurate diagnosis.
Book a consultation with one of our experienced trichologists and set your mind at ease. They will let you know exactly what type of rash you are dealing with and recommend the best treatment.
If you would like to find out more about follicular eczema, be sure to read the answers to the following frequently asked questions.
No, follicular eczema is not an infection. However, you can develop a secondary infection at the site of your follicular eczema if you scratch it vigorously or the skin gets so dry it cracks, letting germs in. If you notice the affected area getting more inflamed and/or you see pus start to form, it can be a sign that it has become infected.
No, follicular eczema is not contagious and it will not be transmitted to another person even if they directly touch the affected area. So there’s no need to worry about shaking hands or sharing articles of clothing with someone who has this condition (it is, however, still a good idea to clean any shared items before and after use, for hygiene reasons).
There is currently no cure for follicular eczema, but flare-ups will normally resolve on their own with home care in 1-3 weeks. If you don’t see any improvement or your symptoms get worse after a month, it is a good idea to see a dermatologist.
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