In short
- Small pustules around follicles — usually bacterial (staph) or fungal (Malassezia).
- Persistent cases need a swab to distinguish bacterial from fungal.
- First-line: antibacterial shampoo + topical clindamycin (bacterial) or antifungal shampoo (fungal).
- Recurrent folliculitis needs a look at hats, helmets, gym towels and shampoo residue.
Scalp folliculitis is inflammation around hair follicles — often small, itchy, sometimes painful pustules on the scalp. Two main types: bacterial (usually staphylococcus) and fungal (usually Malassezia). Treatment differs; getting the type right matters.
How to tell them apart
Bacterial folliculitis: tender pustules, sometimes yellow-headed, may crust. Fungal folliculitis: itchier than tender, more uniform, often after antibiotic use or in humid conditions. A GP or trichologist can swab in ambiguous cases.
Clearance protocol
- Bacterial: chlorhexidine or benzoyl peroxide shampoo, plus topical clindamycin or fusidic acid for 2 weeks.
- Fungal: ketoconazole 2% shampoo 3x weekly for 4 weeks; oral itraconazole in stubborn cases.
- Stop all hair oils and heavy leave-ins during clearance.
- Wash pillowcases and gym towels weekly on 60°C.
Preventing recurrence
Rinse thoroughly after every wash — shampoo residue is a huge driver. Change gym towels frequently. Cycling helmet or work hat should be wiped inside weekly. Avoid heavy pomades on prone scalps.
Folliculitis is usually a residue problem masquerading as a skin problem.
Frequently asked
Common questions
Can folliculitis cause hair loss?+
Persistent, deep folliculitis can scar and cause permanent loss — treat it early and thoroughly.
Is it contagious?+
Bacterial folliculitis can spread via towels or razors. Fungal is not typically person-to-person.
Will growing my hair out worsen it?+
No — length doesn't cause folliculitis. Occlusive products and residue do.
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