Folliculitis is a common skin problem that occurs when a hair follicle, a sac under the skin where hair growth starts from, gets infected by bacteria or fungi. Rarely, the hair follicle can also be infected by a virus. Folliculitis presents as groups of small, raised red bumps or white pustules on the skin. Folliculitis begins with damage to the hair follicles, which happens from shaving, adhesive bandages, and tight clothing, especially tight-fitting synthetic fabrics that cause heat and sweat trapping.

Types of Folliculitis:

  • Hot tub folliculitis is caused by Pseudomonas, the same bacterium that causes otitis externa, or swimmer’s itch. This bacterium is usually found in hot tubs, water slides, and heated pools, even if the water is sufficiently chlorinated. The resulting folliculitis appears on skin as a rash that is extremely itchy or painful. The rash can resolve on its own within 7-10 days but can also spread and worsen to last for months.
  • Barber’s itch also known as “pseudo-folliculitis barbae” is caused by ingrown hairs after close shaving on the face and neck in males, and facial and bikini waxing in females. It can cause pus-filled bumps that can lead to scarring and permanent hair loss. It is important to avoid close shaving or traumatic hair removal methods and to treat underlying inflammation to prevent scarring.
  • Pityrosporum folliculitis, also known as “malassezia folliculitis”, is caused by an infection of malassezia yeast that presents in young adults and men on their chest, back, neck, and shoulders as acne-like bumps and pimples. This form of folliculitis is often misdiagnosed as acne.
  • Sycosis barbae is a chronic infection that involves deeper inflammation of bearded areas in young men caused by shaving. This folliculitis is often caused by a species of Staphylococcus or Propionibacterium bacteria, and it increases in severity of inflammation as trauma from shaving continues. The most common symptoms are intense burning, itching, and pain. These symptoms are exacerbated on the upper lip if patients suffer from seasonal allergies and/or nasal discharge.
  • Gram-negative folliculitis is an acne-like pustular rash caused by a gram-negative bacterial infection such as Escherichia coli, Pseudomonas aeruginosa, Serratia marcescens, Klebsiella, and the Proteus species. This form of folliculitis is often mistaken as a worsening of acne as it usually occurs in patients with acne and rosacea as a complication of using antibiotics.
  • boil is a skin infection caused by staphylococcal bacteria that enters the body through tiny nicks or cuts in the skin and travels down the hair follicles. At first the skin turns red and then a boil develops. A boil is a hard, red, tender dime-sized lump that eventually becomes softer, larger, and more tender and turns white as a pocket of pus collects underneath the skin. Boils usually occur on the face, neck, armpits, shoulders, and buttocks, and can also occur on eyelids as a stye. Patients with history of diabetes, weakened immune system, poor hygiene, and habits of using harsh abrasive and mechanical cleansers are at increased risk for developing boils.
  • carbuncle is a more serious infection when several boils occur in a group or cluster.
  • Eosinophilic folliculitis is a noninfectious recurrent skin disorder that presents with acne-like pimples and pus-heads containing white cells called eosinophils, in HIV/AIDS or transplant patients. Itch is a symptom in half the patients.

What is the treatment for folliculitis?

Application of warm compresses on the affected area using clean washcloths can help. Using over the counter benzoyl peroxide cleansers can also help control the folliculitis. Care must be taken to completely rinse off the benzoyl peroxide from the skin to prevent bleaching of towels and clothing. Sometimes prescription antibiotic creams and solutions are needed for widespread infection or if conservative measures do not help. Oral antibiotics and antifungals can be used to control the infection for severe types of folliculitis. If left untreated, folliculitis can cause large sores and even scars.

Talk to our dermatologist sif your condition is not responding to over the counter treatment options, or if the inflammation is severe. Timely treatment is important to prevent scarring.