An overview of causes and types of folliculitus.

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Home >> Infectious hair diseases >> Folliculitis on the scalp

Folliculitis is the name given to inflammation of hair follicles that can be caused by several factors. Folliculitis is a focal inflammation of the hair follicles. It looks like acne with little rings of inflammation surrounding the opening of a hair follicle. The result of folliculitis is a tender red spot, sometimes with a surface pustule.

Folliculitis causes can be divided broadly into two categories: infectious and non-infectious. Infectious folliculitus is more common than non-infectious folliculitis. Non-infectious folliculitis is caused by oils and greases. Oils and greases, when applied to the skin, clog up the hair follicles and lead to non-infectious folliculitis.

Infectious folliculitis evolves due to the damage of the hair follicles by friction from clothing, shaving, physical injury etc. The damaged hair follicles are invaded by various micro-organisms like bacteria and sometimes viruses which lead to severe infection called folliculitis.

Categories of folliculitis
Folliculitis causes can be divided into two major categories on the basis of the histological location of the inflammation:
  • Superficial
  • Deep
The depth of involvement of the folliculitis in the hair follicle determines whether the folliculitis is superficial or deep. Infectious superficial folliculitis is seen as a tender pustule (a small swelling similar to a blister or pimple) that heals without scarring.

The deep folliculitis is more pronounced than superficial folliculitis. In deep folliculitis, infection extends deep into the follicle, affecting either the entire follicle or the deeper portion of the follicle. It leads to inflammation and reddening which may be with or without a pustule. The lesions are painful and they may lead to scarring.

To identify the intensity of folliculitis the best procedure is to obtain a professional diagnosis. Swabs should be taken from the pustules for culture in the laboratory. Both superficial and deep infectious folliculitis can be caused by various micro-organisms including:

  • Bacteria
  • Fungi
  • Viruses
  • Parasites
Various types of Superficial Folliculitis
Bacterial Folliculitis
The most common bacterial folliculitis causes are the Staphylococcus bacteria. Staphylococcus bacterial folliculitis is probably more common in those who have eczema and diabetes. It generally affects the face, scalp, upper trunk, buttocks and eyelids. Because of the superficial nature of the process, involvement of the scalp rarely leads to scarring, although temporary hair loss may occur.

The common types of superficial folliculitis caused by Staphylococcus bacteria are “Hot Tub” Folliculitis and Barber's itch. 'Hot Tub Folliculitis' generally grows in contaminated whirlpools, hot tubs, water slides, swimming pools and physiotherapy pools. The skin infection manifests as multiple blisters with pus which may develop in denser patches under swimsuit areas.

Barber itch is another type of superficial bacterial folliculitis which is marked by itchy, white, pus-filled lumps in the beard area of men. It is also sometimes seen on the legs or underarms of women who shave these areas.

Fungal and Yeast Folliculitis
Superficial fungal and yeast infections are found in the top layers of the skin while deep fungal and yeast infections invade deeper layers of the skin and hair follicles. In extreme cases, it can spread to the blood or internal organs. Yeast or fungal folliculitis causes are related to:
  • Dermatophytes
  • Malassezia
  • Candidia
  • Trichophyton
Dermatophytes are the most common mold-like fungi. They are responsible for Tinea Capitis on the scalp. Tinea capitis results in the formation of dry scaling like dandruff and hair breakage.

Malassezia folliculitis, was previously called ‘pityrosporum folliculitis’. It is due to proliferation of a yeast, called malassezia, within the hair follicles. It presents as an itchy, acne-like eruption and most often affects the trunk. It is superficial in its intensity.

Candida folliculitis is a skin infection caused by the Candida yeast. It can be seen on the scalp and in occluded moist areas, such as under the breasts and in the groin areas of obese people. The infection is manifested as pustules and nodules.

Trichophyton folliculitis is mostly seen in women who shave their legs. It is presumed that the inflammation spreads from an athlete’s foot fungal infection.

Viral folliculitis
The Viral folliculitis causes are commonly viral micro-organisms like herpes simple virus (HSV). The superficial viral conditions appear as small circumscribed elevations on the skin that contain serum on a reddened base. They often form pustular or ulcerated lesions, and eventually a crust. Viral folliculitis generally affect the beard area.

Parasitic folliculitis
Parasitic folliculitis causes are usually small micro-organisms that burrow into the hair follicle to live or lay their eggs. These parasites cause Follicular Pityriasis, a skin disease characterized by epidermal shedding of flaky scales from the skin and eruptions in the scalp with or without pus.

Deep folliculitis
Deep folliculitis various types like Gram-negative folliculitis, boils, carbuncles and eosinophilic folliculitis.

Gram-negative folliculitis
Gram-negative folliculitis causes are generally a result of long-term antibiotic acne treatments. Antibiotics alter the normal balance of bacteria in the body, leading to an overgrowth of harmful organisms. When chronic, gram-negative folliculitis leads to the formation of severe acne type lesions on the jaws and cheeks.

Boils and carbuncles
Boils and carbuncles occur when hair follicles become deeply infected with staphylococcus bacteria. Boils are generally cured completely in about two weeks. Small boils usually heal without scarring, but a large boil may leave a scar. A carbuncle is a cluster of boils together that often occurs on the back of the neck, shoulders or thighs of older men. Carbuncles cause a deeper and more severe infection than boil, heal slowly and are likely to leave scars.

Eosinophilic folliculitis
Eosinophilic folliculitis is seen generally in HIV-positive people. This type of folliculitis is characterized by recurring patches of inflamed, pus-filled sores. It is primarily evident on the face and sometimes on the back or upper arms.

There are various treatments for these infectious diseases but before taking up any treatment the potential for side-effects should be considered.

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