Folliculitis is a common skin condition in which hair follicles become inflamed. It's usually caused by a bacterial or fungal infection. At first it may look like small red bumps or white-headed pimples around hair follicles — the tiny pockets from which each hair grows. The infection can spread and turn into nonhealing, crusty sores.

The condition isn't life-threatening, but it can be itchy, sore and embarrassing. Severe infections can cause permanent hair loss and scarring.

If you have a mild case, it'll likely clear in a few days with basic self-care measures. For more serious or recurring folliculitis, you may need to see a doctor.

Certain types of folliculitis are known as hot tub rash, razor bumps and barber's itch.

Folliculitis signs and symptoms include:

  • Clusters of small red bumps or white-headed pimples that develop around hair follicles
  • Pus-filled blisters that break open and crust over
  • Red and inflamed skin
  • Itchy or burning skin
  • Tenderness or pain
  • A large swollen bump or mass

When to see a doctor

Make an appointment with your doctor if your condition is widespread or the signs and symptoms don't go away after a few days. You may need an antibiotic or an antifungal medication to help control the problem.

Types of superficial folliculitis

Superficial forms of folliculitis include:

  • Bacterial folliculitis. This common type is marked by itchy, white, pus-filled bumps. When bacterial folliculitis affects a man's beard area, it's called barber's itch. It occurs when hair follicles become infected with bacteria, usually Staphylococcus aureus (staph). Staph bacteria live on the skin all the time. But they generally cause problems only when they enter your body through a cut or other wound.
  • Hot tub folliculitis (pseudomonas folliculitis). This type is caused by pseudomonas bacteria. You may be exposed to these bacteria in many places, including hot tubs and heated pools in which the chlorine and pH levels aren't well-regulated. You may develop a rash of red, round, itchy bumps one to four days after exposure. These may later develop into small pus-filled blisters (pustules).

    The rash is likely to be worse in areas where your swimsuit held contaminated water against the skin or where skin — such as the back of the thighs — came in direct contact with a contaminated surface.

  • Barber's itch (pseudofolliculitis barbae). This is an inflammation caused by ingrowing hairs. It mainly affects black men who shave and is most noticeable on the face and neck. People who get bikini waxes may develop barber's itch in the groin area. This condition may leave dark raised scars (keloids).
  • Pityrosporum (pit-ih-ROS-puh-rum) folliculitis. This type is especially common in teens and adult men. It's caused by a yeast infection and produces chronic, red, itchy pustules on the back and chest and sometimes on the neck, shoulders, upper arms and face.

Types of deep folliculitis

Deep folliculitis, where the whole hair follicle is involved, comes in various forms:

  • Sycosis barbae. This type affects men who have begun to shave. At first, small pustules appear on the upper lip, chin and jaw. They become more prevalent over days and weeks as shaving continues. Severe sycosis barbae may cause scarring.
  • Gram-negative folliculitis. This type sometimes develops if you're receiving long-term antibiotic therapy for acne. Antibiotics alter the normal balance of bacteria in the nose. This leads to an overgrowth of harmful organisms called gram-negative bacteria. In most people, this doesn't cause problems, and the bacteria in the nose return to normal once antibiotics are stopped. In a few people, the gram-negative bacteria spread to the skin around the nose and mouth. This can cause new, severe acne.
  • Boils (furuncles) and carbuncles. These occur when hair follicles become deeply infected with staph bacteria. A boil usually appears suddenly as a painful pink or red bump. The surrounding skin also may be red and swollen. The bump then fills with pus and grows larger and more painful before it finally ruptures and drains. Small boils usually heal without scarring. A large boil may leave a scar.

    A carbuncle is a cluster of boils. It usually appears on the back of the neck, shoulders, back or thighs. A carbuncle causes a deeper and more severe infection than does a single boil. As a result, it develops and heals more slowly and is likely to leave a scar.

  • Eosinophilic (e-o-sin-o-FILL-ik) folliculitis. This type mainly affects people with HIV/AIDS. Symptoms include intense itching and recurring patches of inflamed, pus-filled sores on the scalp, face, neck and upper chest. The sores usually spread and often leave areas of darker than normal skin (hyperpigmentation) when they heal. The exact cause of eosinophilic folliculitis isn't known. But it may involve the same yeast-like fungus responsible for pityrosporum folliculitis.

Folliculitis is caused by an infection of hair follicles, usually from the bacteria Staphylococcus aureus. Folliculitis may also be caused by viruses, fungi and even an inflammation from ingrown hairs.

The condition is classified as either superficial or deep, based on how much of the hair follicle it involves. Deep folliculitis is usually more severe.

Follicles are densest on your scalp, and they occur everywhere on your body except your palms, soles, lips and mucous membranes. Damaged follicles are at risk of infection.

The most common causes of follicle damage are:

  • Friction from shaving or tight clothing
  • Heat and sweat, such as that caused by wearing rubber gloves or waders
  • Certain skin conditions, such as dermatitis and acne
  • Injuries to your skin, such as from scrapes or surgical wounds
  • Coverings on your skin, such as plastic dressings or adhesive tape

Anyone can develop folliculitis. But certain factors make you more susceptible to the condition, including:

  • Having a medical condition that reduces your resistance to infection, such as diabetes, chronic leukemia and HIV/AIDS
  • Having acne or dermatitis
  • Past damage to your skin, as from injury or surgery
  • Taking some medications, such as steroid creams or long-term antibiotic therapy for acne
  • Being overweight
  • Regularly wearing clothing that traps heat and sweat, such as rubber gloves or high boots
  • Soaking in a hot tub that's not maintained well
  • Shaving

Possible complications of folliculitis include:

  • Recurrent or spreading infection
  • Large, itchy patches of infected skin (plaques)
  • Boils under the skin (furunculosis)
  • Permanent skin damage, such as scarring or dark spots
  • Destruction of hair follicles and permanent hair loss

You're likely to start by seeing your primary care doctor. He or she may refer you to a doctor who specializes in skin disorders (dermatologist).

To get the most from your appointment, it's a good idea to be well-prepared. Here's some information to help you get ready.

What you can do

  • List any symptoms you're experiencing, including those that seem unrelated to your skin condition.
  • List key personal information, including any major stresses or recent life changes.
  • List all medications, vitamins and supplements you're taking.
  • List questions to ask your doctor.

For folliculitis, some basic questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • What are other possible causes for my symptoms?
  • Do I need any tests?
  • What's the best treatment for my condition?
  • I have these other health conditions. How can I best manage them together?
  • What types of side effects can I expect from treatment?
  • Is there a generic alternative to the medicine you're prescribing me?
  • Do you have any relevant brochures or other printed material that I can take home with me? What websites do you recommend?
  • What will determine whether I should plan for a follow-up visit?

Don't hesitate to ask any other questions that occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

  • How long have you had this skin infection?
  • Do you have a history of dermatitis?
  • Does your work or a hobby expose your hands to heat and moisture, such as from wearing rubber gloves?
  • Were you in a hot tub or a heated swimming pool a day or two before you noticed your skin rash?
  • Have your symptoms been continuous or occasional?
  • Does your skin itch? Is it painful to the touch?
  • Does anything seem to improve your symptoms?
  • Does anything make your symptoms worse?

What you can do in the meantime

Sometimes folliculitis goes away without medical treatment. Self-care measures, such as warm compresses and anti-itch creams, can help relieve your signs and symptoms.

Your doctor is likely to diagnose folliculitis by looking at your skin and reviewing your clinical history. If the usual treatments don't clear up your infection, he or she may use a swab to take a sample of your infected skin. This is sent to a laboratory to help determine what's causing the infection. Rarely, a skin biopsy may be done to rule out other conditions.

The treatments you receive for folliculitis depend on the type and severity of your condition, what self-care measures you've already tried and your preferences for treatment. Even if treatment helps, the infection may come back.

Medications

  • Creams or pills to control infection. For mild infections, your doctor may recommend the antibiotic cream mupirocin (Bactroban). Oral antibiotics aren't routinely used for folliculitis. But for a severe or recurrent infection, your doctor may prescribe them.
  • Creams, shampoos or pills to fight fungal infections. Antifungals are for infections caused by yeast rather than bacteria, such as pityrosporum folliculitis. Antibiotics aren't helpful in treating this type.
  • Creams or pills to reduce inflammation. If you have mild eosinophilic folliculitis, your doctor may suggest you try a steroid cream. If your condition is severe, he or she may prescribe oral corticosteroids. Such drugs can have serious side effects and should be used for as brief a time as possible.

    If you have HIV/AIDS, you may see improvement in your eosinophilic folliculitis symptoms after antiretroviral therapy.

Other interventions

  • Minor surgery. If you have a large boil or a carbuncle, your doctor may make a small incision in it to drain the pus. This may relieve pain, speed recovery and help lessen scarring. Your doctor may then cover the area with sterile gauze in case pus continues to drain.
  • Light therapy with a medicated cream. Also called photodynamic therapy, this technique has helped people with folliculitis that did not clear up with other treatments. In a study of seven people who each had one treatment of photodynamic therapy, six people showed significant improvement four weeks later. In another study of one man, the technique completely cleared his folliculitis. And he remained free of symptoms 15 months after the last treatment.
  • Laser hair removal. If other treatments fail, laser therapy may clear up the infection. This method is expensive and may require several treatments. It permanently reduces the density of the hair in the treated area. Other possible side effects include discolored skin, scarring and blistering.

Mild cases of folliculitis often respond well to home care. The following self-care approaches may help relieve discomfort, speed healing and prevent an infection from spreading:

  • Apply a warm, moist washcloth or compress. Do this several times a day to relieve discomfort and help the area drain, if needed. Moisten the compress with a saltwater solution (1 teaspoon of table salt in 2 cups of water).
  • Apply over-the-counter antibiotics. Try various nonprescription infection-fighting gels, creams and washes.
  • Apply soothing lotions. Try relieving itchy skin with an oatmeal lotion or an over-the-counter hydrocortisone cream.
  • Clean the affected skin. Gently wash the infected skin twice a day with antibacterial soap. Use a clean washcloth and towel each time and don't share your towels or washcloths. Use hot, soapy water to wash these items. And wash clothing that has touched the affected area.
  • Protect the skin. If possible, avoid shaving. If you must shave, try an electric razor. When you're done, rinse your skin with warm water and apply moisturizer.

You can try to prevent folliculitis from coming back with these tips:

  • Avoid tight clothes. It helps to reduce friction between your skin and clothing.
  • Dry out your rubber gloves between uses. If you wear rubber gloves regularly, after each use turn them inside out, rinse with soap and water, and dry thoroughly.
  • Avoid shaving, if possible. For men with barber's itch, growing a beard may be a good option if you don't need a clean-shaven face.
  • Shave with care. Use an electric razor or a clean, sharp blade every time you shave. Adopt habits such as:

    • Washing your skin with warm water and a mild facial cleanser before shaving
    • Using a wash cloth or cleansing pad in a gentle circular motion
    • Applying lubricating shaving cream or gel for five to 10 minutes before shaving to soften the hair
    • Applying moisturizing lotion after you shave

    Generally, men with barber's itch have been advised to shave in the direction of hair growth. But a study found that men who shaved against the grain saw their rash improve. Experiment to see what works for you. You may even want to consider hair-removing products (depilatories) or other methods of hair removal.

  • Use only clean hot tubs and heated pools. And if you own a hot tub or a heated pool, clean it regularly and add chlorine as recommended.
Aug. 21, 2014