When hair follicles are damaged, they may be invaded by viruses, bacteria and fungi, leading to infections such as folliculitis. Superficial folliculitis affects the upper part of the hair follicle and the skin directly next to the follicle. Deep folliculitis affects the deeper portion of the follicle and can involve the entire hair follicle.
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 for prescription medicine.
Certain types of folliculitis are known as hot tub rash, razor bumps and barber's itch.
Hot tub folliculitis
Hot tub folliculitis causes red, round, itchy bumps that may later develop into small pus-filled blisters. The rash is likely to be worse in areas where your swimsuit holds contaminated water against your skin.
Razor bumps (pseudofolliculitis barbae) affects men with curly beards. It develops when shaved hairs curve back into the skin, leading to inflammation.
A carbuncle is a cluster of boils — painful, pus-filled bumps — that form a connected area of infection under the skin.
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
- Itchy, burning skin
- Painful, tender skin
- 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 condition.
Types of folliculitis
The two main types of folliculitis are superficial and deep. The superficial type involves part of the follicle, and the deep type involves the entire follicle and is usually more severe.
Forms of superficial folliculitis include:
- Bacterial folliculitis. This common type is marked by itchy, white, pus-filled bumps. 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). With this type you may develop a rash of red, round, itchy bumps one to two days after exposure to the bacteria that causes it. Hot tub folliculitis is caused by pseudomonas bacteria, which is found in many places, including hot tubs and heated pools in which the chlorine and pH levels aren't well-regulated.
- Razor bumps (pseudofolliculitis barbae). This is a skin irritation caused by ingrown hairs. It mainly affects men with curly hair who shave too close 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 produces chronic, red, itchy pustules on the back and chest and sometimes on the neck, shoulders, upper arms and face. This type is caused by a yeast infection.
Forms of deep folliculitis include:
- Sycosis barbae. This type affects males who have begun to shave.
- Gram-negative folliculitis. This type sometimes develops if you're receiving long-term antibiotic therapy for 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. A carbuncle is a cluster of boils.
- Eosinophilic (e-o-sin-o-FILL-ik) folliculitis. This type mainly affects people with HIV/AIDS. Signs and symptoms include intense itching and recurring patches of bumps and pimples that form near hair follicles of the face and upper body. Once healed, the affected skin may be darker than your skin was previously (hyperpigmented). The cause of eosinophilic folliculitis isn't known.
Folliculitis is most often caused by an infection of hair follicles with Staphylococcus aureus (staph) bacteria. Folliculitis may also be caused by viruses, fungi and even an inflammation from ingrown hairs.
Follicles are densest on your scalp, and they occur everywhere on your body except your palms, soles, lips and mucous membranes.
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
- Taking some medications, such as steroid creams or long-term antibiotic therapy for acne
- Being a male with curly hair who shaves
- 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
- Causing damage to hair follicles by shaving, waxing or wearing tight clothing
Possible complications of folliculitis include:
- Recurrent or spreading infection
- Boils under the skin (furunculosis)
- Permanent skin damage, such as scarring or dark spots
- Destruction of hair follicles and permanent hair loss
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 razor bumps (pseudofolliculitis), growing a beard may be a good option if you don't need a clean-shaven face.
- Shave with care. If you shave, adopt habits such as the following to help control symptoms by reducing the closeness of the shave and the risk of damaging your skin:
- Shaving less frequently
- Washing your skin with warm water and antibacterial soap before shaving
- Using a washcloth or cleansing pad in a gentle circular motion to raise embedded hairs before shaving
- Applying a good amount of shaving lotion before shaving
- Shaving in the direction of hair growth, though one study found that men who shaved against the grain had fewer skin bumps. See what works best for you.
- Avoiding shaving too close by using an electric razor or guarded blade and by not stretching the skin
- Using a sharp blade and rinsing it with warm water after each stroke
- Applying moisturizing lotion after you shave
- Avoiding the sharing of razors, towels and washcloths
- Considering hair-removing products (depilatories) or other methods of hair removal. Though they, too, may irritate the skin.
- 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.
- Talk with your doctor. Depending on your situation and frequency of recurrences, your doctor may suggest controlling bacterial growth in your nose with a five-day regimen of antibacterial ointment and using a body wash with chlorhexidine (Hibiclens, Hibistat). Further study is needed to prove the effectiveness of these steps.