What is folliculitis?
Folliculitis is a common condition that is often found on the face, arms, upper back and lower legs. There are many different types, but all are marked by inflammation (swelling), infection or irritation of the hair follicle (a space within the skin that holds the root of a hair and the oil glands). When these follicles become infected or irritated, redness, irritation, itching and bumps can develop.
What are the types of folliculitis?
The types of folliculitis include the following:
- 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 resolves (gets better) within a few days and can be cared for at home. In severe cases, however, folliculitis should be treated by a medical professional.
- 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 great deal like the one caused by the staphylococcal species. Sometimes the rash is itchy. Hot tub folliculitis typically fades on its own within a few days, but some patients 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, usually on the upper chest and back. This form of folliculitis is aggravated (made worse) 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 African-American men.
- 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.
- Gram-negative folliculitis: Gram-negative folliculitis can occur after prolonged antibiotic use to treat acne. Over time, resistant bacteria grow and multiply, resulting in worsening acne.
- 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.
- Carbuncles: A carbuncle forms when several boils appear in one spot. Carbuncles are usually larger and are the combination of multiple infected hair follicles.
- Eosinophilic folliculitis: This condition is usually seen in patients who are immunosuppressed (the immune system is not fully functioning). There is also a form that is seen in babies. Eosinophilic folliculitis is not infectious. It is characterized by itchy pustules, most often on the shoulders, upper arms, neck and forehead.
Management and Treatment
How is folliculitis managed and treated?
Some types of folliculitis can be treated at home in the following ways:
- Antibacterial cleansers can help clean the skin, limiting the amount of bacteria on the skin.
- Warm towels can also sooth the irritated skin.
- Anti-itch creams can decrease discomfort.
- Less severe cases of folliculitis, such as Pseudomonas folliculitis (hot tub rash), usually fade within a few days without treatment.
In more severe cases, an oral antibiotic may be needed. Deeper infections, like boils and carbuncles, may have to be drained by a doctor.
Because Pseudofolliculitis barbae and Sycosis barbae heavily affect the beard area, you can reduce their occurrence by:
- 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.
How do I prevent other forms of folliculitis?
Folliculitis infections largely involve bacteria, germs and yeast entering the hair follicles. You can prevent and lessen the impact of folliculitis by:
- Keeping the skin clean.
- Taking care while shaving.
- Checking the chemical disinfectant levels of hot tubs and heated pools before using them.
- Washing off and removing your swimsuit when you get out of a hot tub.
- Wearing breathable clothing to keep sweat from getting trapped between the clothing and skin.
When should I call my doctor about folliculitis?
Though in many cases folliculitis is not serious and fades within a short time, severe cases may need medical treatment. If folliculitis is spreading, or if there are firm, painful or draining bumps, contact your doctor as soon as possible.