Acne Necrotica

Key Points
Inflammatory skin condition involving the hair follicles of the scalp
Most cases are due to infectious organisms, usually bacteria
Occurs in areas susceptible to irritation
Consists of itchy pustules located on hair follicles, often pink or red in color

Scalp folliculitis is a skin condition in which hair follicles of the scalp become inflamed or infected. It consists of itchy pustules located on the affected follicle, and will be surrounding by inflamed tissue that is pink or red in color. Mild cases will be tender and itchy, but in severe cases where the entire follicle becomes involves, lesions may become painful. Lesions may erupt and become crusted. Acne necrotica is a rare, severe form of scalp folliculitis, which consists of larger papules which inflame, then develop a black crust. These lesions leave permanent scars, and the condition may affect other areas, including the face.

All age, gender and ethnic groups can develop scalp Folliculitis. It is commonly due to an infection of the skin by bacteria. Conditions such as diabetes, weakened immune systems, underlying skin conditions, obesity, warm humid climates, and excessive sweating can increase a person's susceptibility to the condition.

Differential Diagnosis (Other conditions with similar appearance)
Acne Vulgaris
Impetigo
Acneiform Eruptions
Insect Bites
Contact Dermatitis
Papular Urticaria
Pruritic papular eruption of HIV disease
Rosacea

Diagnosis
Key Points
Diagnosis based on skin appearance
Laboratory testing may be performed to determine the causal organism

Scalp folliculitis is generally diagnosed based on appearance. Laboratory testing may be performed to determine the causal organism and to rule out similar appearing conditions.

Treatment
Mild cases often treated at home
Goal of treatment is to control symptoms and prevent infection
In severe cases, more aggressive treatment may be pursued by health care professionals
Antibiotics may be prescribed for those patients who experience infection
OTC Options: dandruff shampoos, oral antihistamines, topical antibiotics

Mild cases of folliculitis can often be treated at home. It is recommended that affected persons use dandruff shampoos containing antifungals. Antihistamines may be used to relieve itching and inflammation, and topical antibiotics may help resolve secondary infection. In more severe cases, topical steroids, and oral antibiotics may be prescribed, in addition to Isotretinoin.