What is folliculitis?
Folliculitis is an inflammatory condition that affects hair follicles, and causes them to become red, raised and often infected. Its severity can depend on how deep the infection resides – whether it affects the upper part of the follicle just below the surface of the skin (called the infundibulum) or lies lower down, deeper in the skin (the isthmus of the hair follicle). Simple folliculitis which affects only the infundibulum is less serious and more easily treated. But deeper infections such as acne necrotica and folliculitis decalvans can result in scarring and permanent hair loss. Furthermore, folliculitis is common in black skin which can lead to keloid (raised) scarring.
What causes it?
There can be many causes of folliculitis, including bacterial infection, fungal infection, acne and seborrheic dermatitis.
Folliculitis can also start from damage to the skin caused by rubbing, shaving or waxing and where the follicle then becomes vulnerable to infection.
Patients with HIV are also vulnerable to folliculitis as their autoimmune system is often compromised.
Symptoms and signs
Folliculitis can affect men and women, and can appear on any part of the body where hairs grow, including on the scalp, back, buttock and legs. In simple folliculitis, crops of itchy, red or white pustules appear on the skin at the base of the hair shaft.
In more severe case, such as acne necrotica, the follicular spots can develop into blackened crusts, leaving scars.
In folliculitis decalvans, which is mostly found on the scalp, patients usually present with one or more round patches of scarring hair loss (cicatricial alopecia), commonly surrounded by pustules, and crusting on the scalp.
Where bacterial infection is confined to the infundibulum, antiseptic shampoo is usually all that is needed to address the condition.
Fungal infections meanwhile require systemic antifungal preparations, whilst acne needs systemic antibiotics.
Where infections lie deeper in the isthmus of the hair follicle, then prolonged use of systemic antibiotics is recommended, in combination with antiseptic shampoos.
Why see a trichologist?
A trichologist will be able to make or confirm a diagnosis of folliculitis, and will be able to give the patient information as to the prognosis of the condition, advice on treatments and what they should expect in the future.
They will recommend that the patient see their GP and may also recommend referral to a dermatologist, particularly in more severe cases.