Folliculitis

Overview

What is folliculitis?

Folliculitis is a common skin condition that’s often caused by an infected or inflamed hair follicle. It can look similar to acne and be uncomfortable or itchy. Folliculitis often has a psychosocial impact because of its appearance. There are many different types of folliculitis — each one unique based on the cause, the infectious organism and its impact on the skin. Folliculitis can happen as a result of daily activities like shaving, getting in a hot tub, and excess sweating from exercise or outdoor work.

You can have folliculitis anywhere on the body that has hair. Common places include your:

  • Face.
  • Arms.
  • Upper back.
  • Lower legs.

You have hair almost everywhere on your body. Some hairs are so fine that you may not notice they are there, while others are very prominent. Your hair has a larger purpose than appearance — it acts like an insulator, keeping you warm. It’s part of your body’s protection system. The spot where an individual hair enters your skin is called a follicle. The follicle holds the thin hair in place and is home to oil glands.

Unfortunately, follicles can gather bacteria and other materials from the outside world that could cause inflammation or infection. When something is inflamed, it’s swollen. A swollen hair follicle will bulge up and make a bump on the skin. If you have an infected hair follicle, you may experience:

  • Redness.
  • Irritation.
  • Itching.
  • Bumps on the skin.

What are the types of folliculitis?

There are actually many different types of folliculitis. Think of folliculitis like a blanket term — it’s the family that each of these specific types of skin conditions lives under. Each type of folliculitis can have its own appearance, symptoms and cause. Often, the thing that causes the condition is one of the biggest factors that sets each type of folliculitis apart. Location can also play a role — where you experience this condition on your body can change depending on what type of folliculitis you have.

The types of folliculitis include:

  • Staphylococcus aureus folliculitis: Infection of the hair follicle with Staphylococcus aureus bacteria is one of the most common causes of folliculitis. Small red or white pus-filled pimples can be seen on the skin. The affected area often gets better (resolves) within a few days and can be cared for at home. In severe and persistent cases, however, folliculitis should be treated by your healthcare provider.
  • Pseudomonas aeruginosa (“hot tub”) folliculitis: Pseudomonas aeruginosa is a bacteria that thrives in heated, moving water (hot tubs, whirlpools, water slides). It can infect the hair follicle and cause a rash that looks a lot like the one caused by the staphylococcal species. Sometimes the rash is itchy. Hot tub folliculitis occurs one to two days after exposure to the water source and typically fades on its own within a few days. Rarely, some people may need medical treatment.
  • Malassezia folliculitis: Malassezia are a family of yeast that can normally be found on the skin. Sometimes, when Malassezia gets into the hair follicles, it can cause an itchy condition that looks like an acne breakout. It usually occurs on the upper chest and back. This form of folliculitis is made worse (aggravated) by sweat. Using an antidandruff shampoo every day to wash the affected areas of skin is often helpful.
  • Pseudofolliculitis barbae: Also called “razor bumps,” pseudofolliculitis barbae usually occurs in the beard area. After beard hairs are cut with a razor, sharply trimmed edges can turn back into the skin, causing irritation. Pseudofolliculitis barbae is more common in people with curly hair, particularly Black men. Avoidance of shaving or using trimmers can help. If the problem is persistent, you should see a dermatologist as this can lead to scarring.
  • Sycosis barbae: Sycosis barbae is a severe, potentially scarring form of shaving-related folliculitis. The entire hair follicle is infected, resulting in large red pustules. Shaving should be avoided and you should see a dermatologist for discussion of treatment options.
  • Gram-negative folliculitis: Gram-negative folliculitis can happen after prolonged antibiotic use to treat acne. Over time, resistant bacteria grow and multiply. This can lead to your acne actually getting worse. This condition requires treatment from a dermatologist or another healthcare provider.
  • Boils (furuncles): Boils, or furuncles, occur when the hair follicle becomes deeply infected. The boil is often red, tender and painful. It will come to a head after several days and may leave a scar behind. In certain cases, oral medications or procedures are needed to resolve the lesion.
  • Carbuncles: A carbuncle forms when several boils appear in one spot. Carbuncles are usually larger and are the combination of multiple infected hair follicles. As with boils, in certain cases, oral medications or procedures are needed to resolve the lesion.
  • Eosinophilic folliculitis: This condition is usually seen in patients who are immunosuppressed (the immune system is not fully functioning). There’s also a form that’s seen in babies. Eosinophilic folliculitis is not infectious. It is characterized by itchy pustules, most often on the shoulders, upper arms, neck and forehead. They often resolve on their own, but can come back (recur).

How common is folliculitis?

Folliculitis is a very common skin condition that many people will experience throughout their lives. It can happen to men, women, children and infants. Certain types of folliculitis are more likely to happen in particular groups of people. Pseudofolliculitis barbae and sycosis barbae, for example, are two types of folliculitis are closely linked to shaving. These conditions are much more common in men who are frequently cutting beard hairs.

Symptoms and Causes

What are the symptoms of folliculitis?

In most cases, the main symptom of folliculitis is red bumps that look like pimples on your skin. These could also look like they’re white-filled bumps or they could be filled with pus (pustules). Folliculitis can feel itchy and uncomfortable. Many people feel the need to scratch when they have folliculitis. It’s best to try and not scratch at the spots because you don’t want to open them up (this could possibly cause a worse infection of the hair follicle).

What causes folliculitis?

In general, folliculitis is caused when a hair follicle is inflamed (swollen) and infected. This causes the follicle to swell under the skin, creating uncomfortable bumps on the surface of your skin. For many of the specific types of folliculitis, the cause isn’t always known. However, there are certain factors that can increase your risk of developing folliculitis. A few risks can include:

  • If you shave often.
  • If you have been using an oral antibiotic for a long period of time.
  • If you are overweight or obese.
  • If you have a history of diabetes.
  • If you do activities that make you sweat a lot and don’t fully clean off afterwards.
  • If you spend time in a hot tub or sauna that isn’t properly cleaned.

Diagnosis and Tests

How is folliculitis diagnosed?

Folliculitis is usually diagnosed during a physical exam with your healthcare provider. This can be done during an appointment and in most cases, you do not need to see a skincare specialist. Your primary care physician is usually able to diagnose folliculitis and provide a treatment plan. In certain, severe or persistent cases, an appointment with a dermatologist is recommended.

Your healthcare provider will go over your medical history and ask you about your habits. Some questions might include:

  • Have you been sweating more than normal lately or doing activities that cause you to sweat a lot?
  • Have you been in a hot tub or sauna?
  • Do you shave every day?
  • Are you currently taking any medications, including acne treatments?

The answers to these questions often confirm a diagnosis of folliculitis and help your provider determine which type it might be.

In some more severe cases, your provider may refer you to a dermatologist for additional tests to make sure your folliculitis isn’t another medical condition. One test that can be done is a biopsy. This is a test where a small sample of your skin is removed and then taken to a lab where it’s studied.

Management and Treatment

How is folliculitis treated?

Treatment options for folliculitis depend on the type of folliculitis you have and it’s severity. Certain types may need more aggressive types of care, while others may go away with little to no treatment. If your folliculitis is mild, it can sometimes be treated at home. There are several ways you can care for your irritated skin, including:

  • Using antibacterial cleansers to clean the skin. This will limit the amount of bacteria on your skin.
  • Applying warm towels to your irritated skin to sooth the discomfort.
  • Using anti-itch creams.

In less severe types of folliculitis, like Pseudomonas folliculitis (hot tub rash), your symptoms will typically fade within a few days without treatment. If they don’t, reach out to your healthcare provider. When you have a more severe case of folliculitis, oral antibiotics may be needed to treat the condition. Deeper infections, like boils and carbuncles, may have to be drained by your healthcare provider. This will remove the build-up of pus and allow the area to heal. Because Pseudofolliculitis barbae and Sycosis barbae heavily affect the beard area, you can manage these conditions by changing your shaving habits. These changes can include:

  • Softening the hair with hot water before shaving.
  • Shaving with the grain of the hair, not against it.
  • Using a shaving gel or cream.
  • Shaving every other day, rather than daily.
  • Using an electric razor or hair removal product instead of a traditional razor blade.
  • Avoiding pulling the skin while shaving.

Prevention

Can folliculitis be prevented?

In many cases, you can work to prevent folliculitis or manage it by changing your lifestyle habits. Folliculitis infections usually involve bacteria and yeast entering your hair follicles. By changing some parts of your normal self-care routine, you can limit the amount of infectious material in your hair follicles.

A few tips for preventing folliculitis include:

  • Keeping your skin clean.
  • Limiting shaving.
  • Checking the chemical disinfectant levels of hot tubs and heated pools before using them. The warmer a pool or hot tub, the faster the chemicals will fade away — making them less effective against bacteria.
  • Washing off and removing your swimsuit when you get out of a hot tub or pool.
  • Wearing breathable clothing to keep sweat from getting trapped between your clothes and skin.

Outlook / Prognosis

Will folliculitis come back?

Folliculitis can come back again after treatment if you don’t change your hygiene practices and self-care habits. Keeping your skin clean is an important part of its health. It’s also good to know what triggers your folliculitis so you can avoid those things in the future. For example, if you know that you get folliculitis after going in a hot tub, then you might want to make sure the chemicals are at full-strength before getting in.

If you are aware of what caused your folliculitis in the past and change your habits to correct those causes, the chance of it happening over and over is small.

Living With

When should I call my doctor about folliculitis?

Even though many cases of folliculitis can be cared for at home and go away after a short period of time, do not hesitate to call your healthcare provider if you are concerned. In most cases, a quick exam by your provider will tell you if you need treatment for folliculitis or if it will go away on its own. Severe cases of folliculitis do need to be treated and may require an oral medication or small procedure. If you experience any of the following, call your healthcare provider right away:

  • Folliculitis that spreads from the original area to other parts of your skin.
  • Spots that are firm or painful.
  • Any bumps that are draining a fluid.
  • Fevers, chills, fatigue or any other systemic symptoms.

A note from Cleveland Clinic

Folliculitis is a very common condition that many people experience throughout their lifetime. If you notice small red bumps on your arms, legs, face or back and start to experience uncomfortable symptoms (pain, fluid drainage, fever), reach out to your healthcare provider. Folliculitis can often be cared for at home and doesn’t require a trip to your healthcare provider’s office, but if you do have any concerns it’s best to call your provider.

Last reviewed by a Cleveland Clinic medical professional on 06/10/2021.

References

  • American Osteopathic College of Dermatology. Folliculitis. . Accessed 6/23/2021.https://www.aocd.org/page/Folliculitis (https://www.aocd.org/page/Folliculitis)
  • American Academy of Dermatology. Acne-Like Breakouts Could Be Folliculitis. . Accessed 6/23/2021.https://www.aad.org/public/diseases/a-z/folliculitis (https://www.aad.org/public/diseases/a-z/folliculitis)
  • Merck Manual Consumer Version. Folliculitis. . Accessed 6/23/2021.https://www.merckmanuals.com/professional/dermatologic-disorders/bacterial-skin-infections/folliculitis (https://www.merckmanuals.com/professional/dermatologic-disorders/bacterial-skin-infections/folliculitis)
  • Centers for Disease Control and Prevention. Facts About “Hot Tub Rash.” . Accessed 6/23/2021.https://www.cdc.gov/healthywater/swimming/pdf/317355-A_FS-HotTubRashes_508.pdf (https://www.cdc.gov/healthywater/swimming/pdf/317355-A_FS-HotTubRashes_508.pdf)

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