What is folliculitis?

If folliculitis goes untreated it may result in serious or deep infections that may spread or cause permanent scarring, cellulitis, or even enter the bloodstream and become life-threatening.
If folliculitis goes untreated it may result in serious or deep infections that may spread or cause permanent scarring, cellulitis, or even enter the bloodstream and become life-threatening.

Each hair on your body grows out of a pocket in your skin called a follicle. Folliculitis is inflammation of these hair follicles, and it can appear anywhere on your skin where hair grows.

Folliculitis usually looks like small, red, and raised bumps that may contain pus. It is caused by infection or irritation to the skin.

Folliculitis is generally a minor skin condition that may resolve on its own, but it can be a greater health risk for people with compromised immune systems or if it’s left untreated.

Signs of folliculitis

Folliculitis is often confused with acne because the two conditions have similar appearances. However, there are some differences.

Signs of folliculitis include:

  • Clusters of red bumps or pimples with a hair in the center
  • Itchy, burning skin
  • Tender skin
  • Pimples that break open and crust over
  • Deep, swollen masses

Causes of folliculitis

There are two types of folliculitis: superficial folliculitis, which affects the upper part of the follicle and the skin around it; and deep folliculitis, which affects the entire hair follicle deep into the skin.

As bacteria spreads, superficial folliculitis can develop into deep folliculitis and then into abscesses (a collection of pus in tissues).

Types and causes of folliculitis include:

Bacterial folliculitis

This is an infection in the follicle caused by Staphylococcus aureus bacteria. It is the most common form of folliculitis.

Hot tub folliculitis

This is an infection caused by Pseudomonas aeruginosa bacteria. Hot tub folliculitis usually occurs after exposure to poorly treated pool or hot tub water. This type of folliculitis will usually clear up without treatment in a few days.

Razor bumps

Known as pseudofolliculitis barbae, this form is caused by shaving too close to the skin. Hairs can turn back toward the skin and become ingrown. This condition mostly occurs in beard areas of men with curly hair, but it can also appear anywhere that is shaved.

Pseudofolliculitis barbae can develop into deep folliculitis called sycosis barbae. This is a severe form of shaving-related inflammation where the follicle becomes deeply infected. It may cause scarring.

Fungal folliculitis

This form is caused by the Malassezia fungi. This is a kind of yeast normally found on the skin that can enter the hair follicle and cause an itchy infection. Sweat often worsens this condition.

Gram-negative folliculitis

This form of folliculitis is caused by prolonged antibiotic use. Over time, bacteria become resistant to treatment, which results in a worsening infection.

Eosinophilic folliculitis

This type of folliculitis is found in people with compromised immune systems. If your immune system isn’t fully functioning because of HIV, chemotherapy, or other medical treatments, eosinophilic folliculitis may develop. It is an itchy rash that often appears on the shoulders, upper arms, neck, and forehead.

Boils and carbuncles

If folliculitis is left untreated, boils (or skin abscesses) can develop. As the hair follicle becomes deeply infected, the boil will come to a head and may drain. The boil may be painful and red.

A large cluster of boils may also appear as many follicles become infected. This cluster is called a carbuncle.

If boils or carbuncles are left untreated, a serious skin infection may develop called cellulitis. This infection can spread to the lymph nodes and enter the bloodstream and become life-threatening.

When to see the doctor for folliculitis

Some forms of folliculitis, like hot tub folliculitis, usually clear up within a few days on their own without treatment. However, you should seek medical advice if the folliculitis:

  • Becomes hard and painful lumps
  • Is widespread
  • Doesn’t go away after a few days
  • Starts to drain

If you develop symptoms including fever or hot, swollen skin that’s changing quickly, seek medical attention.

Diagnosis of folliculitis

Your doctor will record your symptoms and your personal and medical history, including recent pool or hot tub exposure, long-term antibiotic use, and more. They may also examine your skin and test a sample of fluid or tissue to determine the type of folliculitis.

Treatments for folliculitis

Most types of folliculitis are not serious and can be treated at home. Home treatment can include:

  • Using antibacterial wash to clean the skin and help clear bacteria
  • Washing the scalp and beard with medicated shampoo
  • Applying anti-itch cream to relieve discomfort
  • Using warm compresses to relieve inflammation and pain
  • Wearing loose clothing and changing immediately out of sweaty clothes

Hot tub folliculitis will usually disappear on its own without treatment.

For shaving-related folliculitis, treatment can also include:

  • Shaving every other day or twice a week instead of daily
  • Shaving with the grain of hair instead of against it
  • Using an electric razor instead of a disposable blade
  • Using shaving gel or cream instead of dry shaving

If your skin doesn’t respond to treatment or your condition is moderate to severe, your doctor may prescribe:

  • Topical antibiotic cream
  • Topical steroid cream
  • Antibiotic medication
  • Antifungal medication

Your doctor may also want to drain any boils and carbuncles. If you have recurring folliculitis, they may recommend laser hair removal to destroy the hair follicle.

Infections left untreated may result in serious or deep infections that may spread or cause permanent scarring.

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Medically Reviewed on 1/5/2021
References
American Academy of Dermatology Association: "Acne-Like Breakouts Could Be Folliculitis."

Cochrane Database of Systematic Reviews: "Interventions for bacterial folliculitis and boils (furuncles and carbuncles)."

Dermato-Endocrinology: "Special types of folliculitis which should be differentiated from acne."

Michigan Medicine: "Folliculitis."

Winters, R. and Mitchell, M. StatPearls, StatPearls Publishing, 2020.