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We tend to think of hair and skin as two separate concerns. But the place they meet, at the hair follicle, is precisely where a common and often overlooked type of eczema can show up.
Follicular eczema is a subtype of atopic dermatitis, the most common type of eczema. It forms around individual hair follicles on the body and scalp and occurs more frequently in darker skin tones. Though it is often waved off as goosebumps or just dry skin, dermatologists say the bumpy texture is a documented condition that’s treatable once it’s correctly identified.
“Many of my patients have spent months or even years trying different drugstore products like scrubs and shampoos without knowing there was a diagnosable condition that explains their symptoms,” says Neha Chandan, MD, a double board-certified dermatologist and Mohs surgeon in St. Petersburg, Florida. “Follicular eczema is one of the most common ways eczema presents in skin of color, and yet most patients have never heard the term before they come to see me.”
To help demystify the condition, we asked dermatologists to break down what Black patients should know about follicular eczema. Here are the key things they shared, from getting a correct diagnosis to managing flares and protecting your skin from future irritation.
Meet the Experts
- Neha Chandan, MD, is a double board-certified dermatologist and Mohs surgeon in St. Petersburg, Florida.
- Viktoryia Kazlouskaya, MD, is a double board-certified cosmetic and medical dermatologist in New York City.
Follicular eczema is easy to mistake for something else
“Follicular eczema is seen more commonly in patients with darker skin tones,” says Viktoryia Kazlouskaya, MD, a double board-certified cosmetic and medical dermatologist in New York City. Instead of the typical scaly patches you get with other types of eczema, “it presents as tiny rough bumps centered around the hair follicles,” Dr. Kazlouskaya explains. It can often resemble other conditions, such as keratosis pilaris (KP), which is caused by the buildup of the protein keratin around hair follicles, resulting in small, rough bumps. (As an aside, KP and follicular eczema can look very similar at first glance, but Dr. Kazlouskaya says the distribution of the bumps is one key tell, with KP favoring the backs of the arms, thighs, and cheeks and follicular eczema involving much larger areas of the body.) That kind of resemblance is exactly why it gets missed so often by patients—and sometimes doctors too.
Medical training plays a big role in this. “Historically, most dermatology textbooks and teaching materials contained predominantly images of lighter skin, and many physicians had limited exposure to how common skin diseases appear in patients with darker skin tones,” says Dr. Kazlouskaya. But, she notes, this is shifting, with medical schools, dermatology residency programs, and groups like the American Academy of Dermatology starting to invest more in skin-of-color education.
You can help your dermatologist make the correct diagnosis
Luckily, follicular eczema doesn’t usually require invasive testing to diagnose. “A biopsy is usually not necessary but can be helpful when the diagnosis remains uncertain or when another skin condition needs to be excluded,” Dr. Kazlouskaya says. In most cases, she adds, a medical provider can make their diagnosis through a skin examination alongside a review of the patient’s medical history.
According to Dr. Chandan, you can play an important role in getting correctly diagnosed by coming prepared with detailed information about your symptoms, including itchiness, which can be a meaningful clue even if other indicators of eczema aren’t present, along with anything that seems to make flares worse. Most importantly, don’t be afraid to advocate for a thorough skin exam. She suggests asking your doctor to check the areas most affected section by section, whether that’s your chest, back, arms, or scalp, since a quick glance may not be enough to spot the signs of follicular eczema.
There are plenty of treatment options
Once follicular eczema is correctly identified, it’s treated much like other forms of eczema.
“When inflammation is more significant, prescription anti-inflammatory creams, such as topical corticosteroids or nonsteroidal alternatives, may be needed,” Dr. Kazlouskaya says. “For more severe or widespread disease, phototherapy or systemic treatments, including oral medications or biologic injections, may be appropriate.”
However, the good news is mild cases can be treated with regular use of moisturizers and gentle skin care, says Dr. Kazlouskaya. To that end…
Your skin and scalp care routine may need a makeover
The way you approach daily skin and hair care can also help improve your symptoms. If you’ve been exfoliating with a scalp or face scrub or using occlusive products (like Aquaphor or Vaseline) to moisturize the affected areas, it may be time to make a change.
“The biggest misconception is that the bumps are because of a dirty scalp or clogged pores,” Dr. Chandan says. She says this belief pushes people toward exfoliating, which only fuels more irritation. “The bumps aren’t from buildup but rather from inflammation, and you can’t exfoliate your way out of eczema. In order to effectively treat the skin, you need to calm it, not scrub at it.”
As for using oily or greasy products, Dr. Chandan says they can actually trap inflammation and worsen itching. “It can feel soothing at first, but in the long run, it’s actually doing more harm than good.”
So what is a good routine for follicular eczema? “Mild disease often responds well to regular use of moisturizers and gentle skin and scalp care,” Dr. Kazlouskaya says. The three-step routine below is a good place to start.
Step 1: Cleanse
Wherever you tend to get patches of follicular eczema, cleanse with care. This might mean investing in a gentle body wash, shampoo, or both.
If your body wash could use an upgrade, consider Dove’s Soothing Relief Body Wash With Colloidal Oatmeal. Fragrance-free and formulated for eczema-prone skin, it helps calm irritation without the exfoliants Dr. Chandan warns against. It also has the National Eczema Association’s Seal of Acceptance, so you can rest easy knowing it shouldn’t irritate your skin.
As for the scalp, Dr. Kazlouskaya is a fan of SEEN’s Fragrance-Free Shampoo, which also carries the National Eczema Association’s Seal of Acceptance. “SEEN shampoo is my overall favorite for scalp care for many patients with eczema. It’s free of fragrances and irritating ingredients and has a light texture, yet is able to thoroughly clean the hair and scalp,” she says.
Step 2: Moisturize
Ceramides are fats that help hold moisture in and keep irritants out. Unfortunately, those with eczema often have a deficiency, and studies comparing skin-barrier properties across ethnic groups have found that Black skin tends to have lower levels compared to Caucasian or Asian skin, leaving their skin even more reactive.
CeraVe Moisturizing Cream, which carries the National Eczema Association’s Seal of Acceptance, contains three different types of ceramides to soothe dry skin and help rebuild its protective barrier. It’s exactly the kind of product Dr. Kazlouskaya says mild follicular eczema responds well to.
If you have symptoms on your scalp, Dr. Kazlouskaya says SEEN’s Fragrance-Free Shampoo should be moisturizing enough on its own. However, if you have particularly dry skin, she says you may also benefit from the brand’s Fragrance-Free Restore Scalp Serum, formulated to help relieve dryness while reducing the appearance of flakes and irritation. And, yes, it also has the National Eczema Association’s Seal of Acceptance.
Step 3: Protect
Sunscreen, like La Roche-Posay’s Anthelios Light Fluid Sunscreen SPF 50 formula, helps guard against the post-inflammatory hyperpigmentation follicular eczema can leave behind (more on this below). Bonus: The formula is 100% mineral, fragrance-free, and fast-absorbing and has the National Eczema Association’s Seal of Acceptance, so it’s less likely to aggravate existing flare-ups.
Dr. Kozlovskaya says people with follicular eczema on their scalp should wear a hat when spending time outside. While all hats provide some protection, those made with UPF 50+ fabrics can help block out even more UVA and UVB rays. Brands like Coolibar and Solbari offer a wide array of styles.
You don’t have to live with hyperpigmentation
“For many of my patients, the post-inflammatory hyperpigmentation (PIH) that’s left behind [after a follicular eczema flare] often bothers them more than the bumps initially did, but they rarely bring it up,” Dr. Chandan says.
Her advice: Don’t wait to start treatment for eczema-induced PIH, and don’t assume you have to live with the discoloration. “The earlier we can control the eczema, the less discoloration there is to fade. But there’s quite a bit we can do for the PIH, too, and I always let my patients know they don’t have to live with it if they don’t want to.”
If you’ve been dealing with small, persistent bumps around your hair follicles and nothing over-the-counter has made a difference, Dr. Kazlouskaya says it’s worth a visit to someone who treats skin of color regularly. The sooner it’s caught, the quicker you can get on top of flares, and the less there is to undo.
Additional reporting by Dana Leigh Smith
