Folliculitis

Date Updated: 08/18/2020

Overview

Folliculitis is a common skin condition in which hair follicles become inflamed. It's usually caused by a bacterial or fungal infection. At first it may look like small red bumps or white-headed pimples around hair follicles — the tiny pockets from which each hair grows. The infection can spread and turn into nonhealing, crusty sores.

The condition isn't life-threatening, but it can be itchy, sore and embarrassing. Severe infections can cause permanent hair loss and scarring.

If you have a mild case, it'll likely clear in a few days with basic self-care measures. For more serious or recurring folliculitis, you may need to see a doctor for prescription medicine.

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

Symptoms

Folliculitis signs and symptoms include:

Clusters of small red bumps or white-headed pimples that develop around hair follicles
Pus-filled blisters that break open and crust over
Itchy, burning skin
Painful, tender skin
A large swollen bump or mass

When to see a doctor

Make an appointment with your doctor if your condition is widespread or the signs and symptoms don't go away after a few days. You may need an antibiotic or an antifungal medication to help control the condition.

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.

Forms of superficial folliculitis include:

Bacterial folliculitis. This common type is marked by itchy, white, 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. But they generally cause problems only when they enter your body through a cut or other wound.
Hot tub folliculitis (pseudomonas folliculitis). With this type you may develop a rash of red, round, itchy bumps one to two days after exposure to the bacteria that causes it. Hot tub folliculitis is caused by pseudomonas bacteria, which is found in many places, including hot tubs and heated pools in which the chlorine and pH levels aren't well-regulated.
Razor bumps (pseudofolliculitis barbae). This is a skin irritation caused by ingrown hairs. It mainly affects men with curly hair who shave too close and is most noticeable on the face and neck. People who get bikini waxes may develop barber's itch in the groin area. This condition may leave dark raised scars (keloids).
Pityrosporum (pit-ih-ROS-puh-rum) folliculitis. This type produces chronic, red, itchy pustules on the back and chest and sometimes on the neck, shoulders, upper arms and face. This type is caused by a yeast infection.

Forms of deep folliculitis include:

Sycosis barbae. This type affects males who have begun to shave.
Gram-negative folliculitis. This type sometimes develops if you're receiving long-term antibiotic therapy for acne.
Boils (furuncles) and carbuncles. These occur when hair follicles become deeply infected with staph bacteria. A boil usually appears suddenly as a painful pink or red bump. A carbuncle is a cluster of boils.
Eosinophilic (e-o-sin-o-FILL-ik) folliculitis. This type mainly affects people with HIV/AIDS. Signs and symptoms include intense itching and recurring patches of bumps and pimples that form near hair follicles of the face and upper body. Once healed, the affected skin may be darker than your skin was previously (hyperpigmented). The cause of eosinophilic folliculitis isn't known.

Causes

Folliculitis is most often caused by an infection of hair follicles with Staphylococcus aureus (staph) bacteria. Folliculitis may also be caused by viruses, fungi and even an inflammation from ingrown hairs.

Follicles are densest on your scalp, and they occur everywhere on your body except your palms, soles, lips and mucous membranes.

Risk factors

Anyone can develop folliculitis. But certain factors make you more susceptible to the condition, including:

Having a medical condition that reduces your resistance to infection, such as diabetes, chronic leukemia and HIV/AIDS
Having acne or dermatitis
Taking some medications, such as steroid creams or long-term antibiotic therapy for acne
Being a male with curly hair who shaves
Regularly wearing clothing that traps heat and sweat, such as rubber gloves or high boots
Soaking in a hot tub that's not maintained well
Causing damage to hair follicles by shaving, waxing or wearing tight clothing

Complications

Possible complications of folliculitis include:

Recurrent or spreading infection
Boils under the skin (furunculosis)
Permanent skin damage, such as scarring or dark spots
Destruction of hair follicles and permanent hair loss

Prevention

You can try to prevent folliculitis from coming back with these tips:

Avoid tight clothes. It helps to reduce friction between your skin and clothing.
Dry out your rubber gloves between uses. If you wear rubber gloves regularly, after each use turn them inside out, rinse with soap and water, and dry thoroughly.
Avoid shaving, if possible. For men with razor bumps (pseudofolliculitis), growing a beard may be a good option if you don't need a clean-shaven face.
Shave with care. If you shave, adopt habits such as the following to help control symptoms by reducing the closeness of the shave and the risk of damaging your skin:
- Shaving less frequently
- Washing your skin with warm water and antibacterial soap 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, though one study found that men who shaved against the grain had fewer skin bumps. See what works best for you.
- Avoiding shaving too close by using an electric razor or guarded blade and by not stretching the skin
- Using a sharp blade and rinsing it with warm water after each stroke
- Applying moisturizing lotion after you shave
- Avoiding the sharing of razors, towels and washcloths
Considering hair-removing products (depilatories) or other methods of hair removal. Though they, too, may irritate the skin.
Use only clean hot tubs and heated pools. And if you own a hot tub or a heated pool, clean it regularly and add chlorine as recommended.
Talk with your doctor. Depending on your situation and frequency of recurrences, your doctor may suggest controlling bacterial growth in your nose with a five-day regimen of antibacterial ointment and using a body wash with chlorhexidine (Hibiclens, Hibistat). Further study is needed to prove the effectiveness of these steps.

Diagnosis

Your doctor is likely to diagnose folliculitis by looking at your skin and reviewing your medical history. He or she may use a technique for microscopic examination of the skin (dermoscopy).

If initial treatments don't clear up your infection, your doctor may use a swab to take a sample of your infected skin or hair. This is sent to a laboratory to help determine what's causing the infection. Rarely, a skin biopsy may be done to rule out other conditions.

Treatment

Treatments for folliculitis depend on the type and severity of your condition, what self-care measures you've already tried and your preferences. Options include medications and interventions such as laser hair removal. Even if treatment helps, the infection may come back.

Medications

Creams or pills to control infection. For mild infections, your doctor may prescribe an antibiotic cream, lotion or gel. Oral antibiotics aren't routinely used for folliculitis. But for a severe or recurrent infection, your doctor may prescribe them.
Creams, shampoos or pills to fight fungal infections. Antifungals are for infections caused by yeast rather than bacteria. Antibiotics aren't helpful in treating this type.
Creams or pills to reduce inflammation. If you have mild eosinophilic folliculitis, your doctor may suggest you try a steroid cream to ease the itching. If you have HIV/AIDS, you may see improvement in your eosinophilic folliculitis symptoms after antiretroviral therapy.

Other interventions

Minor surgery. If you have a large boil or carbuncle, your doctor may make a small incision in it to drain the pus. This may relieve pain, speed recovery and lessen scarring. Your doctor may then cover the area with sterile gauze in case pus continues to drain.
Laser hair removal. If other treatments fail, long-term hair removal with laser therapy may clear up the infection. This method is expensive and often requires several treatments. It permanently removes hair follicles, thus reducing the density of the hair in the treated area. Other possible side effects include discolored skin, scarring and blistering.

Lifestyle and home remedies

Mild cases of folliculitis often improve with home care. The following approaches may help relieve discomfort, speed healing and prevent an infection from spreading:

Apply a warm, moist washcloth or compress. Do this several times a day to relieve discomfort and help the area drain, if needed. Moisten the compress with a saltwater solution (1 teaspoon of table salt in 2 cups of water).
Apply over-the-counter antibiotics. Try various nonprescription infection-fighting gels, creams and washes.
Apply soothing lotions. Try relieving itchy skin with a soothing lotion or an over-the-counter hydrocortisone cream.
Clean the affected skin. Gently wash the infected skin twice a day with antibacterial soap. Use a clean washcloth and towel each time and don't share your towels or washcloths. Use hot, soapy water to wash these items. And wash clothing that has touched the affected area.
Protect the skin. If possible, stop shaving, as most cases of barber's itch clear up a few weeks after you stop shaving.

Preparing for an appointment

You're likely to start by seeing your primary care doctor. He or she may refer you to a doctor who specializes in skin disorders (dermatologist).

To get the most from your appointment, it's a good idea to be well-prepared. Here's some information to help you get ready.

What you can do

List any symptoms you're experiencing, including those that seem unrelated to your skin condition.
List key personal information, including any major stresses or recent life changes.
List all medications, vitamins and supplements you're taking.
List questions to ask your doctor.

For folliculitis, some basic questions to ask your doctor include:

What's the most likely cause of my symptoms?
What are other possible causes for my symptoms?
Do I need any tests?
What's the best treatment for my condition?
I have these other health conditions. How can I best manage them together?
What types of side effects can I expect from treatment?
Is there a generic alternative to the medicine you're prescribing me?
Do you have any relevant brochures or other printed material that I can take home with me? What websites do you recommend?
What will determine whether I should plan for a follow-up visit?

Don't hesitate to ask any other questions that occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

How long have you had this skin infection?
Do you have a history of dermatitis?
Does your work or a hobby expose your hands to heat and moisture, such as from wearing rubber gloves?
Were you in a hot tub or a heated swimming pool a day or two before you noticed your skin rash?
Have your symptoms been continuous or occasional?
Does your skin itch? Is it painful to the touch?
Does anything seem to improve your symptoms?
Does anything make your symptoms worse?

What you can do in the meantime

Sometimes folliculitis goes away without medical treatment. Self-care measures, such as warm compresses and anti-itch creams, can help relieve your signs and symptoms.