Folliculitis, Scarring Alopecia & Permanent Hair Loss

Certain unpleasant conditions may, in some cases, lead to severe and permanent hair loss.

Two of those are folliculitis and scarring alopecia.

Folliculitis, scarring alopecia and permanent hair loss

Folliculitis

This is an unpleasant condition that comes in various forms. It is far from rare but it may vary hugely in its effects from one person to another.

As the name suggests, it usually means that some type of infection (bacterial or fungal) has entered into or close by the hair follicles. The symptoms usually involve red or white bumps on the scalp which may or may not be itchy.

These may rupture leaving an open blister which will usually quickly scab over but which might also never entirely go away.

This condition is more commonly found in males with curly hair, those with immune deficiencies (notably HIV+) and there is some, as yet unaccepted, anecdotal evidence that it is more common in females of African heritage.

If untreated, folliculitis can lead to permanent damage to follicles and permanent hair loss as a result. It can also be found in some beards and also at times in other parts of the body such as the neck and chest.

Treatment may not be necessary in all cases but where it is, a doctor may prescribe an antibiotic or anti-fungal regime including possibly specialist hair shampoos.

The good news is that there is no evidence that it is highly contagious or that it runs in families.

Scarring alopecia

This is a catch-all term that in reality, encompasses several different conditions (including folliculitis). It’s also sometimes known as “cicatricial alopecia”.

Some of the other conditions in this category include:

• lichen planopilaris;
• eosinophilic pustular folliculitis;
• follicular degeneration syndrome;
• dissecting cellulitis;
• pseudopelade of Brocq;
• plus many others.

There are some alarming terms in that list but they almost all share the characteristic that they can attack your scalp and hair follicles leading to permanent hair loss and balding.

Diagnosis

It can be difficult or often impossible to accurately diagnose the specific problem affecting your hair based upon a visual inspection alone. Although your doctor or sometimes a hair care specialist will have numerous diagnostic tools at their disposal, it’s not unusual for a scalp biopsy to be required.

That usually involves the removal of a tiny piece of your scalp and its examination under high-powered microscopes that can spot the exact nature of the cellular damage taking place. In combination with other forms of microscopy and culture identification, a firm diagnosis is usually, though not always, possible.

Until such a diagnosis has been undertaken, it may be difficult to precisely recommend a treatment regime.

Treatments

A large number may be available.

For very mild cases with relatively minor hair loss and other effects, your doctor may recommend nothing more than specific medicated shampoos containing one ingredient or another.

Perhaps more commonly, depending upon the exact diagnosis, your doctor may prescribe one or more of:

• corticosteroids through creams and/or via injection into the areas of skin that are affected;
• possibly, isotretinoin or antimalarial medications;
• antibiotics;
• tacrolimus, cyclosporin and methotrexate (all potent drugs used to treat primarily other illnesses though they can sometimes be used, under strictly controlled circumstances, to deal with some forms of alopecia).

Keeping in perspective

Do remember that most cases of hair loss are not attributable to some of these more serious conditions. So, don’t worry at the outset. Instead, get an initial opinion from a hair care specialist or your doctor.