What is Folliculitis? Can it cause hair loss?

Quick Summary: Folliculitis and Hair Loss

• What is Folliculitis? Folliculitis is a condition that refers to inflammation of hair follicles. It is caused by bacterial, fungal, or viral infections, often appearing as red or pus-filled bumps. It can affect any area with hair, including the scalp.
• What Causes Folliculitis: Folliculitis can be triggered by bacterial infections like Staphylococcus aureus, fungal infections, or mechanical irritation. Some forms, like folliculitis decalvans, are more likely to lead to hair loss.
• What are the Symptoms of Folliculitis: Symptoms include small, red bumps, pustules, itching, and tenderness. In severe cases, folliculitis can cause scarring and hair loss.
• How Folliculitis Affects Hair Loss: Chronic or severe folliculitis, particularly folliculitis decalvans, can lead to permanent hair loss due to follicular scarring.
• What Treatment Options are available for Folliculitis: Treatment varies depending on the cause of folliculitis, and may include antibiotics, antifungals, antivirals, and corticosteroids. Medications like minoxidil or finasteride can help promote hair regrowth in cases of hair loss.
• Conclusion: Early intervention is key to preventing folliculitis from causing long-term damage and hair loss, especially in severe forms like folliculitis decalvans.

Do you find yourself frequently itching your head? Have you noticed red bumps appearing on your scalp? Among the many possible causes, one common condition could be folliculitis. In this blog, we’ll delve into everything you need to know about folliculitis, from its causes and symptoms to effective treatments.

What is Folliculitis?

Folliculitis is the inflammation of hair follicles, small organs embedded in the skin that produce hair strands. This condition can result from bacterial, fungal, or viral infections, mechanical irritation, or blockages¹. It often appears as small, red, or pus-filled bumps surrounding hair, resembling acne. While folliculitis can occur anywhere on the body with hair, common sites include the scalp, neck, arms, and thighs, particularly in areas prone to friction or sweating.

What Are the Causes of Folliculitis?

Folliculitis is most commonly triggered by a bacterial infection affecting the superficial or deep hair follicles. However, it can also result from fungi, viruses, or even noninfectious factors. Below are some of the main causative agents associated with folliculitis:

• Superficial Bacterial Folliculitis: Caused by a bacterial species called Staphylococcus aureus, including both methicillin-sensitive and methicillin-resistant strains².
• Gram-Negative Bacterial Folliculitis: Often due to Pseudomonas aeruginosa (“hot tub folliculitis”)³ or bacteria like Klebsiella and Enterobacter, typically after antibiotic use or exposure to contaminated water⁴.
• Pityrosporum Folliculitis: Fungal folliculitis caused by Malassezia species, common in adolescents with oily skin⁵.
• Viral Folliculitis: Most often caused by the herpes virus, presenting in clusters as papulovesicles or plaques⁶.
• Eosinophilic Folliculitis: Occurs mainly in advanced HIV patients or as a rare chemotherapy side effect, presenting as itchy red papules⁷.

Some forms of folliculitis are more likely to contribute to hair loss than others. For instance, gram-negative folliculitis typically affects areas like the nose and mouth, making scalp hair loss unlikely. In contrast, superficial bacterial folliculitis can develop anywhere on the body, including the scalp, and may lead to scarring and hair loss if left untreated.

It is common for patients with itchy scalps to be more prone to folliculitis. The reason being that when you scratch the skin you break the protective skin barrier, making it easier for bacteria to enter.

Symptoms of Folliculitis

Folliculitis symptoms can range from mild to severe and often include:

• Small red or white bumps centered around hair follicles.
• Pustules that may ooze or form crusts in severe cases.
• Itching, tenderness, or a burning sensation.

Left untreated, severe folliculitis can lead to complications such as scarring, hyperpigmentation, and secondary bacterial infections.

Folliculitis and Hair Loss

While mild cases of folliculitis generally do not result in hair loss, more severe or chronic forms can lead to damage. Repeated inflammation can impair the structure of hair follicles, potentially causing scarring that prevents new hair growth, leading to permanent hair loss in affected areas.

Certain forms of folliculitis, particularly folliculitis decalvans, can lead to permanent hair loss⁸. This severe and chronic condition primarily affects the scalp and causes intense inflammation and scarring of the hair follicles. As the follicles become damaged, they can no longer support hair growth, resulting in permanent hair loss in the affected areas.The exact cause of folliculitis decalvans is unknown, but it is believed to result from a reaction to Staphylococcus aureus. In folliculitis decalvans, the scarring process is progressive, which can lead to widespread hair thinning or complete bald patches over time if not properly managed. Early intervention and treatment are crucial to prevent long-term follicular damage and hair loss.

Treatments for Folliculitis

The treatment for folliculitis varies depending on its cause. Bacterial folliculitis is commonly treated with topical or oral antibiotics, while viral folliculitis may require antivirals such as aciclovir or valaciclovir. Fungal folliculitis is managed with antifungal shampoos or creams, and eosinophilic folliculitis often requires corticosteroids, although it can sometimes resolve on its own¹.

These treatments are generally not available over-the-counter, so it is important to consult a healthcare professional before beginning any regimen.

For scalp folliculitis due to folliculitis decalvans, treatment typically involves long-term antibiotics and other medications. However, no specific licensed treatment exists for this condition. The following treatment options have been explored⁹:

• Long-term courses of antibiotics
• Steroid injections to reduce inflammation
• Oral steroids for severe outbreaks
• Isotretinoin for severe or persistent cases
• Immune-based therapies, such as adalimumab, infliximab, tofacitinib, and baricitinib

In cases where hair loss is significant, additional treatments such as minoxidil or finasteride may be recommended to promote hair regrowth. These medications can help manage hair loss, although they should be used under the guidance of a healthcare professional to ensure they are suitable for your condition. At The Treatment Rooms London, we would be happy to advise on routines that may benefit you when managing folliculitis, particularly if this distressing condition is causing you to lose hair. 

Conclusion

Folliculitis is a common condition that can affect hair follicles, causing inflammation, irritation, and, in some cases, hair loss. While most cases are mild and treatable, certain forms, such as folliculitis decalvans, can lead to permanent damage and scarring of the hair follicles, resulting in long-term hair loss. Early diagnosis and appropriate treatment are essential to prevent complications and preserve hair growth. If you experience symptoms of folliculitis, particularly on the scalp, it’s important to consult a healthcare professional to determine the underlying cause and receive targeted treatment. With the right approach, managing folliculitis and mitigating hair loss is possible, ensuring the best outcomes for both scalp health and hair preservation.

References

1. Luelmo-Aguilar J, Santandreu MS. Folliculitis: recognition and management. Am J Clin Dermatol. 2004;5(5):301-10. Available at: https://pubmed.ncbi.nlm.nih.gov/15554731/
2. Chiller K, Selkin BA, Murakawa GJ. Skin microflora and bacterial infections of the skin. J Investig Dermatol Symp Proc. 2001 Dec;6(3):170-4. Available at: https://pubmed.ncbi.nlm.nih.gov/11924823/
3. Bhatia A, Brodell RT. ‘Hot tub folliculitis’. Test the waters–and the patient–for Pseudomonas. Postgrad Med. 1999 Oct 1;106(4):43-6. Available at: https://pubmed.ncbi.nlm.nih.gov/10533506/
4. Neubert U, Jansen T, Plewig G. Bacteriologic and immunologic aspects of gram-negative folliculitis: a study of 46 patients. Int J Dermatol. 1999 Apr;38(4):270-4. Available at: https://pubmed.ncbi.nlm.nih.gov/10321942/
5. Suzuki C, Hase M, Shimoyama H, Sei Y. Treatment Outcomes for Malassezia Folliculitis in theDermatology Department of a University Hospital in Japan. Med Mycol J. 2016;57(3):E63-6. Available at: https://pubmed.ncbi.nlm.nih.gov/27581777/
6. Jang KA, Kim SH, Choi JH, Sung KJ, Moon KC, Koh JK. Viral folliculitis on the face. Br J Dermatol. 2000 Mar;142(3):555-9. Available at: https://pubmed.ncbi.nlm.nih.gov/10735972/
7. Laing ME, Laing TA, Mulligan NJ, Keane FM. Eosinophilic pustular folliculitis induced by chemotherapy. J Am Acad Dermatol. 2006 Apr;54(4):729-30. Available at: https://pubmed.ncbi.nlm.nih.gov/16546603/
8. Otberg N, Kang H, Alzolibani AA, Shapiro J. Folliculitis decalvans. Dermatol Ther. 2008 Jul-Aug;21(4):238-44. Available at: https://pubmed.ncbi.nlm.nih.gov/18715292/#:~:text=Folliculitis%20decalvans%20is%20classified%20as%20primary%20neutrophilic%20cicatricial,in%20the%20development%20of%20this%20disfiguring%20scalp%20disease.
9. British Association of Dermatologists (2012). Available at: https://www.bad.org.uk/pils/folliculitis-decalvans/