Folliculitis of the scalp

Hello, I am a black male, 26 yrs old. I have had folliculitis on the back of my neck and scalp since 2002. It started when I played football and wearing helmets. I used to share helmets with other players and we really didnt keep the helmets clean. The folliculitis started on the back of my neck where the padding from the helmet touched. after high school  the folliculitis continued on my neck but was mild and itchy. I would scratch my neck and then scratch the top of my head and soon enough it spread to the crown of my head. it is worse at the crown of my head because the skin itches more and is very tender. I have been to my general practitioner and 2 dermatologists. my regular doctor put me on the antibiotic Levaquin for about 5 days taking one pill a day. the folliculitis cleared up but came back after about a month . the first dermatologist i went to said immediatley, before doing a culture or blood test, that theres no cure for folliculitis and gave me a compund of salicylic/hydrocort/ clindamyc. it contained the folliculitis but it has not gone away. He took blood and swabbed my neck and told me the results show no infection but I really dont trust him. the 2nd dermatologist i saw said I have ingrown hairs on my scalp from my hair being curly but the hair on the back of my neck is very fine and straight . plus how can i have ingrown hairs all of a sudden on top of my head when I dont shave my head or cut it low and the bumps started after scratching that area badly. plus he said that its not an infection and said there is no point in doing any tests unless I want to "make him richer" so he gave me benzoyl peroxide wash and Ziana which has done nothing. I truly believe that its an infection and would like to try antibiotics but the dermatologists to me are either not honest or just brush me off as the ingrown hair guy . Levaquin is pretty strong and was the only thing that worked, temporarily, but I think thats something. What should I do? and If its an infection, can it be cleared? might I add that the follicultis on the crown of my head is thinning my hair. My 2nd dermatologist thinks its male pattern baldness but my hair was full and thick before the folliculits. Please Help??

[Bhupinder Kaur, MD]

Hello,
One possibility for such folliculitis is acne keloidalis nuchae. It occurs when hairs on the back of the head and neck grow into the skin, become inflamed, and cause scar tissue. These ingrown hairs usually occur following a short haircut on the back of the head and nape of the neck.

Treatment of AKN includes suppression of the inflammation with antibiotics and steroid gels or intralesional steroid injections. So apply antibiotic cream like Neosporin or bactroban. If the symptoms persist then oral antibiotics and steroids may be needed. Please consult a dermatologist in that case.

Larger bumps of AKN present for a while or if not responding to treatments may need surgical removal.
I hope it helps. Take care and regards.