Folliculitis is inflammation of hair follicles due to infection by bacteria or fungus. Symptoms vary based on the type and severity of folliculitis. In many cases, the condition resembles an acne breakout.
Folliculitis can develop on any part of the body that has hair, but it’s more likely to appear on the shoulders, neck, buttocks or armpits. In most cases, it isn’t dangerous, but the affected area may feel sore and itchy.
Mild cases of folliculitis can often be treated at home, but more severe infections should be evaluated and treated by a dermatologist.
Types of Superficial Folliculitis
Folliculitis may affect only the upper part of the hair follicle, near the skin (superficial folliculitis) or the entire hair follicle (deep folliculitis). Superficial forms of folliculitis include:
Bacterial folliculitis: Usually caused by Staphylococcus aureus, this common type of folliculitis results in white, itchy bumps that are filled with pus.
Razor bumps (pseudofolliculitis barbae): This type is caused by ingrown hairs, which form when shaved hairs curl and grow back into the skin. African Americans and people with tightly curled hair are most vulnerable to razor bumps. Less commonly, pseudofolliculitis barbae can occur if you wax, pluck or use chemical depilatories.
Hot tub folliculitis (pseudomonas folliculitis): Sitting in a hot tub or swimming in warm pool water that hasn’t been properly treated can cause a red, bumpy rash, usually in areas covered by your bathing suit. The rash may be itchy. Hot tub folliculitis is triggered by Pseudomonas aeruginosa, a bacterium that thrives in warm, moist places. Symptoms may appear a few hours or several days after exposure.
Pityrosporum folliculitis: This form of folliculitis develops when yeast invades hair follicles and causes pustules that are red and itchy. It typically appears on the chest or back, but sometimes on the neck, shoulders, upper arms or face.
Types of Deep Folliculitis
The four types of deep folliculitis are:
1. Sycosis barbae: This is a more severe form of razor bumps in which large, red pustules form.
2. Gram-negative folliculitis: This pustular rash usually develops on the face. People undergoing long-term antibiotic therapy for acne may be vulnerable to gram-negative folliculitis, since antibiotics alter the balance of bacteria in the skin. Gram-negative folliculitis can also develop as a complication of acne vulgaris or rosacea.
3. Boils and carbuncles: Boils are red, tender lumps that form when bacteria (usually staph bacteria) infect a hair follicle or oil gland. Boils most often develop on the face, neck, armpits, shoulders or buttocks. Carbuncles are boils that develop in a cluster. They are more serious infections.
4. Eosinophilic folliculitis: This type of folliculitis is recurrent and primarily affects people who have HIV/AIDS. Patches of bumps and pimples appear on the face and upper body and are extremely itchy.
Who Gets Folliculitis?
While anyone can develop folliculitis, some illnesses and medications increase the risk. For example, people who have a compromised immune system resulting from conditions such as HIV or diabetes are more susceptible to folliculitis. Folliculitis is also more likely to develop in people who have acne or dermatitis or who use certain medications such as steroid creams.
Lifestyle habits play a role as well. Frequently wearing tight clothes or clothes that trap heat and sweat makes folliculitis more likely.
Folliculitis treatment varies depending on the type. Mild cases can often be managed at home using these self-care tips:
• Apply an over-the-counter antibiotic cream or ointment. If your folliculitis is itchy, apply an anti-itch lotion or hydrocortisone cream as well. Follow the package directions.
• Apply a warm, damp compress several times a day. Leave it on for 15 to 20 minutes. This soothes the skin and helps any fluid that has collected in bumps and pimples to drain.
• Wash the area with antibacterial soap twice a day. Dry yourself with a clean towel each time. Don’t share your towels with others, and wash them in hot water.
• Skip shaving, plucking or waxing for now. If your folliculitis was caused by shaving or another form of hair removal, it’s best to let the hair grow until the folliculitis clears up.
Deep folliculitis should be treated by a dermatologist, as should mild folliculitis that doesn’t respond to home care. The doctor may prescribe a topical antibiotic that is stronger than creams available over the counter. Oral antibiotics typically aren’t necessary unless the infection is severe or recurrent.
If your folliculitis is caused by yeast rather than bacteria, the doctor will likely treat it with an anti-fungal cream, shampoo or pill.
Eosinophilic folliculitis is commonly treated with topical corticosteroids. People with HIV who have eosinophilic folliculitis may be prescribed highly active retroviral therapy and isotretinoin, a vitamin A derivative also used to treat severe acne.
A large boil or a carbuncle may need to be drained by a dermatologist in a procedure called lancing. (Never puncture one yourself.) Lancing should help ease the pain, speed recovery and minimize scarring.
If none of these treatments works, the doctor may recommend laser therapy to clear up the infection.
These measures can help keep folliculitis at bay.
Change your shaving routine. Switching to an electric razor or depilatory cream may help. If you prefer to shave with a regular razor, wash the skin with warm water and a gentle cleanser first. Apply an ample amount of shaving cream or gel (not soap) and let it sit for 5 to 10 minutes to soften the hair. Always use a fresh blade, as a duller blade is more likely to cause ingrown hairs. Shave in the direction your hair grows, then rinse the area with warm water and apply an aftershave lotion or balm.
Avoid oily or greasy skin care products. These can clog follicles and trap bacteria.
Be cautious of hot tubs and pools. Unless you know for sure that they’re clean and well maintained, it’s safest to avoid them.
Wear looser clothing. Garments that are too tight can make the skin warm and sweaty and create friction, all factors that make you more vulnerable to folliculitis.