What is Tufted Hair Folliculitis?

Tufted hair folliculitis is a rare, gradually worsening condition related to scarring hair loss, affecting the scalp. It’s named after the distinctive clumps of five to thirty hairs that come out from a single, enlarged hair follicle opening. Rather than being a separate disease, tufted hair folliculitis is considered a symptom that can be seen along with various conditions causing scarring on the scalp.

What Causes Tufted Hair Folliculitis?

Tufted hair folliculitis is a condition where the hair follicles become inflamed, although the exact reason for this is often not known. This condition is linked to a number of types of hair loss that result in scarring. Essentially, it can be seen as a final stage of hair follicle damage that can occur due to several reasons.

This type of hair loss has been seen in people who have scars from injuries, burns, or surgeries, as well as certain scalp conditions, such as acne keloidalis (bumps at the back of the head), folliculitis decalvans (a rare form of hair loss that mainly affects the scalp), dissecting cellulitis of the scalp (a rare condition that causes pockets of pus on the scalp), tinea capitis (a fungal infection of the scalp), lichen planus (an inflammatory condition that can affect the skin, hair, and nails), and pemphigus vulgaris (a rare skin disorder that causes blisters and sores).

Some reports also show that tufted hair folliculitis can occur due to the use of certain drugs, including cyclosporin, trastuzumab, and lapatinib. Some experts believe that tufted hair folliculitis could develop from pre-existing inflammation of the hair follicle, while others think that it is a specific type of folliculitis decalvans, as both conditions have similar characteristics when viewed under a microscope.

Risk Factors and Frequency for Tufted Hair Folliculitis

Tufted hair folliculitis is a quite rare condition and mostly occurs in adults, particularly those in their 40s and 50s. Nonetheless, there have been a few reported cases in younger people, including some who have a syndome called Gobello Nevus. The condition has been reported in people from the age of ten up to 68 years old. There’s no particular racial group that’s more prone to this condition, but it is seen more often in men, with nearly three times as many men having it as women.

Tufted hair folliculitis is a rare condition.
It’s most often found in adults in their 40s and 50s.
Some rare cases have been reported in younger patients.
People with Gobello Nevus syndrome can also get it.
The reported age range of patients is from 10 to 68 years old.
The condition affects all races equally.
It’s more common in males, with a ratio of 2.7 males for every female affected.

Signs and Symptoms of Tufted Hair Folliculitis

Tufted hair folliculitis is a condition where patients experience discomfort in the scalp, such as pain, itchiness, and swelling. This often leads to gradual hair loss. There’s also a common report of crust-like scales appearing around the hair follicles. The issue usually begins in a specific area of the scalp, and then slowly spread out.

The most notable sign of this condition is the appearance of clumps of hair growing out from the scalp, looking similar to a doll’s hair. The affected scalp will have patches of hairless scarred skin mixed in with clumps of hair. Though this condition prefers to show up on the top and back of the head, it can potentially affect the entire scalp. Less commonly, it may also infect the beard. While there are generally no pus-filled bumps, some pus may ooze out from the enlarged openings of the hair follicles.

The inflammation of the scalp can vary, with symptoms such as redness, swelling, pain, or even a spongy feeling. It all relies on how long the condition has been present and what caused the hair to clump up in the first place. There has also been a reported case where the hair clumps were arranged in a linear pattern.

Testing for Tufted Hair Folliculitis

If you have tufted hair folliculitis, a condition where clusters of hair emerge from the same follicle, a special procedure known as trichoscopy might be used for evaluation. This procedure allows doctors to closely observe your scalp using a dermoscope, a special magnifying tool. They’ll look for scaly skin and a starburst pattern of white surrounding the hair follicles; both signs of scarring. They might also see blood vessels between follicles.

To understand the root cause of your tufted hair, a scalp biopsy can be done. In this procedure, a tiny piece of scalp tissue is removed for analyzing. If you also have another underlying condition causing hair loss and scarring, like lichen planus, typical skin changes related to that condition can be detected. The biopsy might also show the extent of your scarring and how active the inflammation is, providing further details about the state of the condition.

In some cases, bacterial tests might show the presence of Staphylococcus bacteria. However, this bacteria isn’t present in all tufted hair folliculitis cases and treating it doesn’t necessarily cure the condition. In most cases, tests for fungal infections, which are sometimes related to scalp problems, come back negative.

Treatment Options for Tufted Hair Folliculitis

Treating tufted hair folliculitis – a condition causing inflamed hair follicles and hair to clump together – is challenging, as there are no recognized treatment methods. If a specific cause can be identified, treatment will be focused on tackling this underlying condition. Otherwise, the aim of any treatment is to ease discomfort and improve the person’s appearance.

Using shampoos containing ingredients like salicylic acid or tar derivatives could help reduce skin flaking. However, these are usually not enough to fully address the issue. Similarly, using creams or lotions with steroids can help with redness, swelling, and itching, but their effects are generally limited and short-lived.

If clear signs of infection, like oozing pus, are present, antibiotics that fight against Staphylococcus bacteria may be beneficial. A certain combination of oral antibiotics, rifampicin and clindamycin, has been found to give good results. Nadifloxacin – a topical antibiotic cream or lotion -also has been tried with at least one patient and showed good results, but it requires further evaluation with a larger number of patients.

Other treatments, like zinc sulfate, methotrexate, and isotretinoin, have been found to be ineffective. Surgical removal of the scarred bald patches, a method known as excision, can provide an improved cosmetic effect for those with tufted hair folliculitis. However, care must be taken with this approach, as post-surgical scarring can actually be a cause of this condition.

Here are some conditions that may need to be considered: