Everything you need to know about folliculitis
A follicle is a small skin cavity from which hair grows. Every single hair on the human body grows from its own follicle.
While folliculitis may appear on any area of the body (except the lips, palms of the hands, and soles of the feet), it most commonly affects the arms, legs, buttocks, genitals, chest, back, head, and face. The condition presents as small red bumps which may have a white, pus-filled tip.
Although uncomfortable, folliculitis is a relatively harmless condition that can affect people of all ages.
Causes and risk factors
Folliculitis may be caused by shaving.
Folliculitis is generally caused by a bacterial infection, commonly Staphylococcus aureus, or staph. However, fungal infections, viruses, and physical trauma to the follicle can all contribute to folliculitis.
Folliculitis is linked to:
- tight hair braids
- tight clothing
- ingrown hairs
- clothing that rubs the skin
- sweat or personal products that irritate the follicle
- skin-clogging substances, such as tar and motor oil
- covering the skin with non-breathable items, such as tape or plastic
- skin conditions, such as acne or dermatitis
- injuries to the skin, including cuts or insect bites
- using an unclean hot tub or swimming pool
- an infected cut or wound (which allows bacteria to spread to nearby hair follicles)
- weakened immune system caused by conditions, such as HIV or cancer
- being overweight or obese
- long-term use of some medications, including antibiotics or steroid creams
Symptoms and complications
Symptoms of folliculitis may include red skin, tenderness and pus-filled sores.
Image credit: Da pacem Domine, 2017
In the initial stages, folliculitis may look like a rash, a patch of small red bumps, or yellow- or white-tipped pimples. Over time, this can spread to nearby hair follicles and progress to crusty sores.
The condition can affect one or many follicles and may last a short time (acute case) or persist long-term (chronic case).
Signs and symptoms include:
- small red bumps
- white-headed pimples
- pus-filled sores
- crusty sores
- red skin
- inflamed skin
- mild fever
Although folliculitis is not life-threatening, some complications may arise. These include:
- furunculosis - boils under the skin
- scars or dark patches
- permanent hair loss due to follicle damage
- recurrent follicle infections
- infections that spread to other areas
- cellulitis - infection of the skin
There are several forms of folliculitis, which can be either superficial or deep. Deep folliculitis affects more of the hair follicle and has more severe symptoms.
Superficial forms include:
- Bacterial folliculitis. A common type of folliculitis characterized by pus-filled pimples that itch. This type is usually caused by a staph infection, which normally lives on the skin but enters deeper tissues through a wound or other damage to the skin.
- Pseudofolliculitis barbae. Also known as barber's itch, this type of folliculitis is caused by ingrown hairs. It affects up to 60 percent of black men and others with curly hair. It may also affect people in the genital area.
- Pseudomonas folliculitis. More commonly known as hot tub folliculitis, this is caused by a type of bacteria (pseudomonas) that is found in pools and hot tubs where the chlorine levels and pH balance are not adequately monitored. Symptoms usually appear within 72 hours of exposure and are most prevalent on the areas of the body covered by a swimsuit or on the back of the legs. Minor symptoms can resolve without treatment within 5 days.
- Pityrosporum folliculitis. A yeast infection of the skin which leads to chronic lesions that are red and itchy. It most commonly affects the face and upper body and is particularly prevalent in young adults and adult men.
Forms of deep folliculitis include:
- Sycosis barbae. A deeper form of barber's itch that can cause scarring and permanent hair loss.
- Boils. Staph bacteria which deeply infect the follicle and lead to boils (furuncles) that are swollen and filled with pus. They continue to grow larger and become very painful until they rupture and drain. Clusters of boils (known as carbuncles) cause more severe symptoms than single boils. Scarring may result from large boils or carbuncles.
- Gram-negative folliculitis. People with acne who are on long-term antibiotic therapy may experience this deep form of folliculitis, as antibiotics affect the bacterial balance in the skin. The condition usually clears up once a person has finished their antibiotic treatment.
- Eosinophilic folliculitis. People with poorly controlled HIV, late stage AIDS, or cancer are most likely to experience this form of folliculitis. Symptoms are intense and recurrent and can cause hyperpigmentation (dark patches of skin). The cause is unknown, but some researchers suggest that a hair follicule mite may be the root cause of eosinophilic folliculitis.
Doctors tend to diagnose folliculitis based on a physical examination. The doctor may examine the skin, take note of symptoms, and review the person's medical and family history.
They may take a swab of the infected skin to test for which bacteria or fungus has caused the folliculitis.
In rare cases, a skin biopsy may be required to exclude the possibility of other causes.
The treatment for folliculitis varies based on the type and severity of the condition.
Mild cases often only require home remedies. However, severe or recurrent cases may need medication or other therapies.
Available treatments include:
An unclean hot tub can lead to folliculitis. Mild cases may be treated with home remedies and severe cases may be treated with medication.
Image credit: James Heilman, MD, 2013
A variety of medications are available for folliculitis. They can be prescribed to treat either bacterial or fungal infections, depending on the cause of the condition. Anti-inflammatory drugs may also be recommended.
Forms of medication include:
- topical antibiotic creams
- oral antibiotics
- topical antifungal creams
- antifungal shampoos
- oral antifungals
- steroid creams
- oral corticosteroids
According to some research, light therapy, or photodynamic therapy, can help improve symptoms of deep folliculitis.
Light therapy is sometimes used to treat acne, and uses both light and a chemical substance to kill bacteria, fungi, and viruses.
Sometimes a doctor will drain a boil or carbuncle by making a small incision in the lesion to drain the pus. The aim is to reduce pain and encourage a faster recovery time.
Laser hair removal
Laser therapy may help reduce folliculitis and cure the infection. It destroys the hair follicles so they cannot get inflamed or infected.
Several treatments are usually necessary to see results.
A number of home remedies are very effective at treating folliculitis and its symptoms. They include:
- Warm compresses. Placing a warm compress on the affected area can reduce itching and draw out pus. To make a compress, simply soak a cloth in warm water and wring out the excess. Apply to the skin for up to 20 minutes. Repeat as needed.
- Over-the-counter products. Several topical creams, gels, and washes are available for folliculitis without a prescription.
- Good hygiene. Gently washing the affected area twice daily with a mild soap will help reduce the infection. Always use clean hands. A washcloth is not recommended as it can cause further irritation to the skin. Use a clean towel for drying. Wash all towels after use to reduce the risk of transmitting the infection.
- Soothing bath. Soaking in a tub of warm water may help reduce the itching and pain associated with folliculitis. Adding oatmeal or an oatmeal-based product can be helpful, as research suggests it has anti-inflammatory properties. Alternatively, one cup of baking soda added to a bath may also ease symptoms. Thoroughly dry the skin after bathing.
- Protect the skin. Avoid wearing tight or irritating clothing, reduce the risk of exposing the skin to harsh chemicals and skincare products, and try to limit shaving and trim instead when possible. When shaving, use a lubricant, and keep the blade clean and sharp.
To prevent folliculitis, avoid or reduce exposure to the causes of the condition. These include:
- tight clothing
- irritating clothing
- harsh chemicals or irritating personal care products
- improper shaving techniques
- blunt or unclean shaving tools
- improperly treated hot tubs and pools
- spending too long in sweaty clothing
A person should also treat underlying medical conditions and speak with a doctor if taking medications that increase the risk of folliculitis.