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Scalp Folliculitis According to the NHS: Causes & Treatments
Dr Peter Thomas (GMC)
Medically reviewed by
Dr Peter Thomas (GMC)
Updated on February 2, 2024

Scalp folliculitis, according to the NHS, is usually not serious, though it often causes pain, inflammation and itchiness. It is a common scalp problem that can occur in people of any age or gender, however some are more predisposed to it.

The tell-tale signs of scalp folliculitis are small pimples and pustules at the base of your hair strands, around your hair follicles [1]. This can look unappealing and cause discomfort, but the good news is that mild cases often resolve in a few days, with little or no treatment needed. 

However, since scalp folliculitis usually involves a bacterial infection, it can, on rare occasions, become severe and produce complications, such as scarring alopecia and permanent hair loss. That is why it is a good idea to see a trichologist if your symptoms worsen or fail to subside after a few days. 

Keep reading this article to find out more about:

  • What scalp folliculitis is according to the NHS and how it manifests
  • What causes scalp folliculitis
  • NHS prevention and treatment for scalp folliculitis
  • The relationship between scalp folliculitis and hair loss
  • Other types of folliculitis you need to be aware of
Table of Contents

What is scalp folliculitis?

scalp folliculitis on the neck

Folliculitis, according to the NHS, is a common skin condition which occurs when hair follicles anywhere on your body (but especially your face, scalp, arms and legs) become infected or inflamed, forming a pustule or pimple around the base of your hair shaft [10]. 

Normally, it is mild and doesn’t present complications in otherwise healthy individuals, but it can take more severe forms in people who have weakened immune systems. Left untreated, it can lead to a worsening and spreading of the infection [1][2]. 

As its name reveals, scalp folliculitis is an inflammation of the hair follicles on your head. Folliculitis is one of the most common scalp issues and it often resolves itself without treatment, but it also responds well to medication, such as topical antibiotics [1].

However, in rare cases, untreated scalp folliculitis can progress, causing complications that can lead to scarring and hair loss [2].

What are the symptoms of scalp folliculitis?

folliculitis on the hairline

In its mild and moderate forms, scalp folliculitis has the following main symptoms [1][2]:

On rare occasions, infection can progress and penetrate deeper into the tissue, creating abscesses or boils. That is why it is a good idea to see a dermatologist or a trichologist if you experience any of the following:

  • Pain or inflammation that increases in intensity with time instead of subsiding.
  • Fever or chills
  • Larger boils or abscesses forming on your scalp
  • Inflamed balding patches 
  • Symptoms that do not seem to improve after a few days of home care
  • If you’ve recently had a hair transplant 

What causes scalp folliculitis?

Scalp folliculitis, according to the NHS and medical literature, can have several causes, some of which are infectious and others which are not [1][2][3][4]:

Scalp folliculitis causes
Bacteria

Scalp folliculitis is most often caused by bacterial infection. In most cases, the infection is superficial, only manifesting with small pustules surrounding the hair follicle, but sometimes it can be deep (boils can form as it spreads to the deeper layers of the follicle).

 

A condition known as hot tub folliculitis can also develop from exposing your scalp to bacteria growing in improperly treated warm water, such as a pool or jacuzzi.

FungiPityrosporum folliculitis is fungal in nature and it is caused by Malassezia furfur, the same fungus which causes yeast infections on the scalp, such as dandruff or seborrheic dermatitis.
VirusesUsually caused by the herpes simplex virus (which also causes cold sores), viral folliculitis often manifests with plaques on the skin instead of pustules.
ParasitesIn rare cases, scalp folliculitis can be caused by demodex mites, which may live in your hair follicles and sebaceous glands. This may sound worrying, but almost all humans have demodex mites around their scalp and they rarely cause medical problems.
A weakened immune systemWhile most types of folliculitis develop more frequently in immunocompromised people, there are certain types, such as eosinophilic folliculitis, which are specific to HIV-positive patients or people undergoing chemotherapy.
Other causes

Researchers are still trying to understand what causes some types of non-infectious scalp folliculitis, which is likely a combination of genetic predisposition, a weakened immune system and the presence of bacteria.

One of these is folliculitis decalvans, a rare condition which leads to scarring alopecia through the destruction of the hair follicle [5]. It is also known as “tufted folliculitis”, as hair emerges from the affected area in groups or tufts [6].

Who is more predisposed to developing scalp folliculitis?

While anyone can develop scalp folliculitis, regardless of their age or gender, you may be more prone to experience this condition [1][2] if you:

  • Have a weakened immune system 
  • Have a scalp condition such as eczema or seborrheic dermatitis
  • Are undergoing chemotherapy or immunosuppressive treatment
  • Have been diagnosed with diabetes mellitus
  • Have been diagnosed with HIV
  • Have a history of cold sores
  • Have been using topical steroid creams for hair loss or for other conditions on your scalp for a long time
  • Have been experiencing malnutrition (especially vitamin D deficiency)
  • Have been spending a lot of time in a shared hot tub or warmed pool
  • Are male, with coarser, darker hair 
  • Have been experiencing acne 
  • Have been shaving your head frequently
  • Have recently had a hair transplant

Will scalp folliculitis eventually go away without treatment?

Whether your scalp folliculitis will resolve itself without treatment depends on what has caused it, the severity of the condition and the strength of your immune system. 

It is common for mild forms of scalp folliculitis to resolve themselves in 7-10 days without medical intervention [7]. However, if the symptoms persist or worsen in time, you will likely need treatment to keep the infection from spreading and to avoid damage to your hair follicles.

Even with treatment, certain severe forms of scalp folliculitis, such as folliculitis decalvans, may continue to flare up over time, as there is no known permanent cure for it. 

How do you treat scalp folliculitis?

The treatment for scalp folliculitis varies in accordance with the microorganisms which caused it:

Type of folliculitis

Treatment [3]

Bacterial scalp folliculitis

Topical or oral antibiotics

Viral scalp folliculitis

If needed, antivirals such as aciclovir or valaciclovir, antihistamines

Fungal scalp folliculitis

Topical antifungal creams or lotions, or shampoos containing selenium sulphide

Parasitic folliculitis

5% topical permethrin cream, which is used to treat scabies and other mites

Eosinophilic folliculitis

Topical or oral corticosteroid medication if needed, but spontaneous resolution can also occur

Folliculitis decalvans

Inflammation can be reduced by long-term combined courses of antibiotics and other medicines. However, there is currently no permanent cure for this condition. It may go into spontaneous remission and then flare up again.

However, be sure you get the recommendation of a medical professional before taking any of these medications, as they can have unwanted side effects or interfere with other treatments you are taking.

Moreover, some treatments for folliculitis, according to the NHS, will not be over the counter (especially antibiotics) [15].

Home remedies for scalp folliculitis

If you have a mild form of scalp folliculitis and would like to try to relieve its symptoms at home, here are some things you can do:

  • Wash your scalp gently with antibacterial soap, to help eliminate the harmful bacteria which may be causing your infection.
  • If you suspect you might have dandruff or seborrheic dermatitis, wash your scalp with an anti-dandruff shampoo, as the same fungus which is causing these conditions may also be causing your folliculitis
  • Apply warm compresses to your scalp for 15 minutes several times a day
  • Avoid scratching your scalp, to prevent the spreading or worsening of the infection
  • Use a cooling powder on your scalp to relieve any itchiness

How do you prevent scalp folliculitis?

There are several things that you can do to lower your chances of developing scalp folliculitis:

  • Keep your scalp clean, especially in hot, humid weather. 
  • Avoid wearing hats for extended periods of time in a warm environment.
  • Avoid frequent use of warmed public pools or hot tubs and wash your hair after using them. 
  • Get treatment for any scalp conditions that you are aware of, such as dandruff, seborrheic dermatitis, eczema or scalp acne.
  • If you shave your head, make sure the instruments you use are thoroughly cleaned.
  • Wash your hands thoroughly and disinfect frequently touched surfaces (e.g. door handles) if you share a home with someone who has scalp folliculitis. 
  • Avoid sharing hats or headgear with others.
  • If you have had hair restoration surgery, make sure you respect all the hair transplant aftercare instructions provided by your surgeon.

Can scalp folliculitis cause hair loss?

Scalp folliculitis normally shouldn’t cause hair loss beyond some hair shedding if you scratch the affected area of your scalp vigorously (it is highly recommended to avoid doing that, as it can also spread the infection).

However, there are a few situations where scalp folliculitis can indeed cause hair loss and it is advisable to seek the help of a trichologist to stop or reverse this process:

  • If the folliculitis is left untreated and spreads deeper into the tissue, it can cause scarring and thus, permanent damage to the hair follicle. If that happens, new hair will not grow out of the damaged follicle anymore and you can experience patchy alopecia.
  • If you have folliculitis decalvans, which causes inflammation that can lead to scarring [5]. Getting treatment in a timely fashion can help reduce the inflammation and limit the scarring you are experiencing. 
hair loss caused by folliculitis
  • If you have dissecting cellulitis of the scalp. It is a rare, severe and chronic inflammatory condition of the scalp which manifests with painful, oozing lumps, abscesses and patchy areas of hair loss. It is normally treated with long-term courses of antibiotics, but some cases can require surgery [8]. 
dissecting cellulitis
  • If you are already under significant psychological stress and the added discomfort of experiencing folliculitis adds to the pressure. This can lead to stress-induced hair thinning, known as telogen effluvium. However, this type of hair shedding is not permanent and should reverse itself in a few months, provided you remove some of the stress from your life. 
  • If you have recently had hair restoration surgery, you have slightly increased odds of developing scalp folliculitis after your hair transplant, due to improper aftercare, badly dissected grafts or poor graft placement (that is why it is important to only get hair restoration surgery at one of the best hair transplant clinics). This can happen anytime between a few days to six months after your hair transplant. If it does, it may place your new hair grafts at risk of delayed or inhibited growth [9].
folliculitis after a hair transplant

Other types of folliculitis

As previously stated, folliculitis is not limited to your scalp and can develop on other parts of your body which are covered in hair as well, including areas where the hairs may be very small and fine, such as your face. Here are some of the most common types of folliculitis which are usually encountered on other parts of your body.

Folliculitis barbae

folliculitis barbae

This type of folliculitis is, according to the NHS, an inflammation of the hair follicles in your beard. Similarly to scalp folliculitis, it is most frequently caused by bacteria, but it can also be fungal or viral in nature or can occur after a beard transplant gone wrong. Your chin is prone to folliculitis, as it is close to the nose (where bacteria is often found) and it is also shaved frequently, giving microorganisms more chances to get under your skin [10].

The symptoms of folliculitis barbae are the same as with most types of folliculitis: painful, raised spots or pustules around the beard follicles, tender, itchy skin and crusting. 

If the beard infection gets deeper into the skin layers, it can develop into sycosis barbae, which causes swollen, tender, pus filled lumps and can cause permanent scarring and hair loss.[11]

However, there is also a condition which masquerades as beard folliculitis, but isn’t really an infection. It is called pseudofolliculitis, or razor bumps, and it is caused by irritation or inflammation caused by shaving and ingrown hairs [11]. This can have similar symptoms to folliculitis, according to the NHS [10][12].

ingrown hairs
Ingrown hairs, which can look like folliculitis, according to the NHS [12]

Facial folliculitis

facial folliculitis

Also mostly caused by bacteria, facial folliculitis is quite common and often encountered in people who are already experiencing acne. One of the most frequent forms of this condition is Bockhart’s impetigo, which causes domed, yellow pustules surrounded by red, inflamed circles [7]. 

Facial folliculitis can also develop often from using public pools or hot tubs, but also following antibiotic treatment for acne (4% of people who have received such treatment develop this condition [7]).

Fortunately, facial folliculitis is commonly self-limiting, which means it will likely resolve in 7-10 days with or without treatment. But if it penetrates deeper into the layers of the skin, it can require topical antibiotics to improve.  

Epilating folliculitis

Epilating folliculitis

This type of folliculitis is often found on the arms, legs, armpits or pubic area – the areas which are frequently subject to hair removal. It usually occurs in women, due to the fact they wax significantly more than men. 

Epilating folliculitis happens due to a combination of the inflammation caused when pulling the hair out from its root and the fact that the hair follicle remains more open to bacteria which could infect it. It manifests as a red rash on the waxed area, with raised bumps and pustules, and can take 2-3 weeks to develop post-waxing [13]. 

Using new, clean wax and disinfecting the area before and after epilation can help prevent this type of folliculitis from occurring. 

In most cases, epilating folliculitis will resolve on its own in a few days. However, it can rarely develop into severe folliculitis with keloid scars, which require treatment with topical and systemic antibiotics to improve [14].

NHS treatments for folliculitis

Your local pharmacist may be able to help you with certain medications for folliculitis, depending on how your condition presents itself. Antifungal creams, antibacterial soaps, and topical antiviral medicines are often available over the counter.

If you have folliculitis due to an ingrown hair, your NHS GP may also be able to:

  • Remove the hair using a sterile needle or scalpel.
  • Prescribe antibiotics to treat bacterial infections.
  • Prescribe a steroid cream to reduce swelling.
  • Refer you to a specialist dermatology clinic for further testing.

In many cases, folliculitis will clear up on its own. But if you have concerns about your condition, or you’ve exhausted all your options on the NHS, speak to a private trichologist for more support and information.

Are you concerned you may have scalp folliculitis?

If you suspect you might have scalp folliculitis, it is a good idea to book a consultation with one of our top trichologists, at your most convenient clinic locations. They will perform a thorough scalp exam and give you an accurate diagnosis, as folliculitis can be easily mistaken for other scalp conditions, such as acne, pseudofolliculitis, scabies or keratosis pilaris.

They will also provide the right treatment which will prevent your condition from worsening or spreading. Getting any scalp problem diagnosed and treated in a timely manner will keep your scalp in good condition and prevent hair loss, leaving you with beautiful, healthy hair.

Scalp Folliculitis According to the NHS: Causes & Treatments, Wimpole Clinic

Dr Peter Thomas (GMC)
Medically reviewed by Dr Peter Thomas (GMC)Updated on February 2, 2024
The Wimpole Clinic offers FUE Hair, Beard & Eyebrow Transplants & Trichology.
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