Folliculitis

Overview

Folliculitis is a common skin condition that happens when hair follicles become inflamed. It's often caused by an infection with bacteria. At first it may look like small pimples around the tiny pockets from where each hair grows (hair follicles).

The condition can be itchy, sore and embarrassing. The infection can spread and turn into crusty sores.

Mild folliculitis will likely heal without scarring in a few days with basic self-care. More-serious or repeat infections may need prescription medicine. Left untreated, severe infections can cause permanent hair loss and scarring.

Certain types of folliculitis are known as hot tub rash and barber's itch.

Symptoms

Folliculitis signs and symptoms include:

• Clusters of small bumps or pimples around hair follicles
• Pus-filled blisters that break open and crust over
• Itchy, burning skin
• Painful, tender skin
• An inflamed bump

When to see a doctor

Make an appointment with your health care provider if your condition is widespread or the symptoms don't go away after a week or two of self-care measures. You may need a prescription-strength antibiotic or antifungal medication to help control the condition.

Seek immediate medical care if you experience signs of a spreading infection. These include a sudden increase in redness or pain, fever, chills, and a feeling of being unwell (malaise).

Types of folliculitis

The two main types of folliculitis are superficial and deep. The superficial type involves part of the follicle, and the deep type involves the entire follicle and is usually more severe.

Types of folliculitis, with the most common listed first, include:

• Bacterial folliculitis. This common type is a rash of itchy, pus-filled bumps. It occurs when hair follicles become infected with bacteria, usually Staphylococcus aureus (staph). Staph bacteria live on the skin all the time. And they can cause problems when they enter the body through a cut or other wound.
• Hot tub rash (pseudomonas folliculitis). This type is a rash of round, itchy bumps that can show up 1 to 2 days after exposure to the bacteria that causes it. Hot tub folliculitis is caused by pseudomonas bacteria, which can be found in hot tubs, water slides and heated pools in which the chlorine and pH levels aren't correct.
• Razor bumps (pseudofolliculitis barbae). This rash can look like folliculitis but it's caused by ingrown hairs, not infected follicles. It mainly affects people with curly hair who shave too close and is most noticeable on the face and neck. People who get bikini waxes may get razor bumps in the groin area.
• Pityrosporum (pit-ih-ROS-puh-rum) folliculitis. This type is a rash of itchy, pus-filled bumps, most often on the back and chest. It's caused by a yeast infection.
• Gram-negative folliculitis. This type causes pus-filled bumps around the nose and mouth. It sometimes develops in people who are receiving long-term antibiotic therapy for acne.
• Eosinophilic (e-o-sin-o-FILL-ik) folliculitis. This type causes intense itching and recurring patches of bumps and pimples that form near hair follicles of the face and upper body. It mainly affects people with HIV/AIDS. The cause of this condition isn't fully understood.
• Boils (furuncles) and carbuncles. These occur when hair follicles become deeply infected with staph bacteria. A boil tends to appear suddenly as a painful inflamed bump. A carbuncle is a cluster of boils.
• Sycosis barbae. This type affects people who shave.

Causes

Folliculitis is often caused when hair follicles are infected with bacteria, commonly Staphylococcus aureus (staph). It may also be caused by viruses, fungi, parasites, medications or physical injury. Sometimes the cause isn't known.

Risk factors

Anyone can develop folliculitis. Certain factors increase the risk of getting it, including:

• Regularly wearing clothing that traps heat and sweat, such as rubber gloves or high boots
• Soaking in a hot tub, whirlpool or public pool that's not maintained well
• Causing damage to hair follicles through shaving, waxing, wearing tight clothes or hair styling practices such as traction, wigs and oils
• Using some medications, such as corticosteroid creams, prednisone, long-term antibiotic therapy for acne and certain chemotherapy drugs
• Having dermatitis or excessive sweating (hyperhidrosis)
• Having diabetes, HIV/AIDS or another condition that lowers your resistance to infections

Complications

Possible complications of folliculitis include:

• Recurrent or spreading infection
• Permanent scarring
• Patches of skin that are darker (hyperpigmentation) or lighter (hypopigmentation) than before the condition occurred, usually temporary
• Destruction of hair follicles and permanent hair loss

Prevention

You can try to prevent folliculitis by using these tips:

• Wash your skin regularly. Use a clean washcloth and towel each time and don't share your towels or washcloths.
• Do laundry regularly. Use hot, soapy water to wash towels, washcloths and any oil-soaked uniforms or other clothing.
• Avoid friction or pressure on your skin. Protect skin that's prone to folliculitis from the friction caused by backpacks, helmets and tight clothes.
• Dry out your rubber gloves between uses. If you wear rubber gloves regularly, after each use turn them inside out, wash with soap, rinse and dry well.
• Avoid shaving, if possible. For people with facial folliculitis, growing a beard may be a good option if you don't need a clean-shaven face.
• Shave with care. If you shave, adopt these habits to help control symptoms:
  • Shaving less often
  • Washing your skin with warm water and a mild facial cleanser (Cetaphil, CeraVe, others) before shaving
  • Using a washcloth or cleansing pad in a gentle circular motion to raise embedded hairs before shaving
  • Applying a good amount of shaving lotion before shaving
  • Shaving in the direction of hair growth
  • Avoiding shaving too close by using an electric razor or guarded blade and by not stretching the skin
  • Using a clean, sharp blade and rinsing it with warm water after each stroke
  • Avoiding shaving the same area more than twice
  • Applying moisturizing lotion after you shave
  • Avoiding the sharing of razors, towels and washcloths
• Try hair-removing products (depilatories) or other methods of hair removal. Though they, too, may irritate the skin.
• Treat related conditions. If you know that a condition other than folliculitis is triggering your symptoms, treat that condition. For example, excessive sweating (hyperhidrosis) can cause folliculitis. You can try to prevent this by changing out of sweaty clothing, bathing daily and using antiperspirant.
• Use only clean hot tubs and heated pools. The Centers for Disease Control also suggests that after getting out of the water you remove your swimsuit and shower with soap. Then wash your swimsuit too. If you own a hot tub or a heated pool, clean it regularly and add chlorine as recommended.
• Talk with your health care provider. If your folliculitis often returns, your health care provider may suggest controlling bacterial growth in your nose. You might need a five-day course of a prescription antibacterial ointment. And you may need to use a body wash with chlorhexidine (Hibiclens, Hibistat, others).