u/mariussep

Hi everyone,

I'm hoping someone here might have some insight because this has been affecting me for years now.

Several years ago I accidentally shaved my scalp way too aggressively with clippers. I basically gave myself a lot of small cuts and irritation. Shortly after that I started developing inflamed bumps on the back and crown of my scalp. Ever since then, the inflammation has never completely gone away.

My doctor diagnosed it as folliculitis, but it has become chronic. The inflammation is mainly on the crown and back of my scalp, although I occasionally get a few lesions elsewhere.

The worst part is that it has started leaving scars, which honestly scares me much more than the bumps themselves. I'm worried that if I can't stop the inflammation, I'll continue getting more permanent scarring over time.

So far I've tried:

Oral lymecycline/tetracycline

Topical clindamycin/dalacin

Benzoyl peroxide (Basiron)

Ketoconazole shampoo (Fungoral)

Tea tree oil

Aloe vera gel

Gentle cleansing

Avoiding close shaving

I'm currently using Differin (adapalene)

I've ordered Clinisoothe Skin Purifier, which I'll start using daily.

One thing that has frustrated me is that no biopsy or bacterial/fungal culture has ever been taken. My doctor felt it wouldn't change the treatment, but I'm seriously considering insisting on both a biopsy and cultures because I really want to know exactly what I'm dealing with.

The frustrating thing is that oral and topical antibiotics work, but only while I'm using them. Once I stop, the folliculitis gradually comes back again.

After giving Differin enough time to work, I'm planning to try Hibiclens (chlorhexidine). If that still doesn't fix it, I'm strongly considering photodynamic therapy (PDT).

Isotretinoin (Accutane) has also been suggested, but I'm honestly very hesitant because of the potential side effects. My biggest concern is dry eyes, since I already feel like I have mild dry eye symptoms, and I'm worried Accutane could make them significantly worse. That said, if it's ultimately the best chance of stopping the inflammation and preventing further scarring, I'm willing to consider it.

My questions are:

Does this sound like "just" chronic bacterial folliculitis, or could it be something like folliculitis decalvans, acne necrotica, or another scarring scalp condition?

Has anyone else developed persistent folliculitis after a traumatic shave or skin injury?

Would you recommend insisting on a biopsy and bacterial/fungal cultures before trying isotretinoin?

Has anyone had success with PDT for chronic scalp folliculitis?

If you've taken Accutane for scalp folliculitis, did it clear it long-term, or did it come back after stopping?

Is there anything else you would try before moving on to Accutane?

I'd really appreciate hearing from anyone who's been through something similar. This has been going on for years, and while the inflammation itself is frustrating, it's the progressive scarring that worries me the most. I really want to stop this before I lose more hair follicles and end up with more permanent scars.

I prioritize clean eating and an active lifestyle.

Thanks in advance for any advice or experiences!