Folliculitis is a skin condition involving an inflammation of the hair follicles. The condition is usually triggered by a bacterial infection or fungal infection. The pimple-like bumps associated with the condition can be itchy, uncomfortable, and embarrassing.
Definition & Facts
Follicles are the tiny pouches from which each hair grows. It is possible to have folliculitis anywhere on the body that has hair; however, it is most often seen on the back, arms, legs, buttocks, and beard area. Mild cases of folliculitis typically resolve on their own in a few days with self-care measures; however, recurrent bouts of folliculitis or serious infections may require treatment by a doctor.
Folliculitis is classified as superficial or deep based on how much of the hair follicle is involved. Hot tub rash, razor bumps, and barber’s itch are examples of superficial folliculitis. Boils and carbuncles are examples of deep folliculitis, which involves an infection of the entire hair follicle.
Symptoms & Complaints
- Recurrent or systemic infection.
- Skin boils, also known as furunculosis.
- Permanent scarring or dark spots.
- Permanent hair loss resulting from the destruction of hair follicles.
- Large patches of infected skin called plaques.
It is important to consult a doctor if the rash spreads, keeps recurring, or if it is accompanied by a fever over 101°F (38°C). These could be signs of a serious systemic infection.
Common causes of folliculitis include bacterial infections such as Staphylococcus aureus infection. The condition can also be caused by viruses and fungi, including herpes simplex and yeast. It is also possible to develop folliculitis when the hair follicles become damaged, irritated, or blocked. The following activities and conditions can increase a person’s likelihood of developing folliculitis:
- Wearing tight clothes that cause friction.
- Using poor shaving technique.
- Wearing items that trap sweat, such as rubber gloves.
- Using a pool or hot tub that has not been adequately cleaned and chlorinated.
- Working with or using substances that can block hair follicles, including makeup, cocoa butter, creosote, tar, and motor oil.
- Having an infected cut or scrape.
- Having a weakened immune system or condition that lowers the body’s ability to fight infections.
- Other skin conditions, including acne or dermatitis.
- Being overweight.
- Taking long-term antibiotics or steroid therapy.
Athletes, such as football players and wrestlers, are prone to developing folliculitis since they often have superficial skin abrasions related to their sports participation. Pregnant women may also develop the condition, which typically resolves on its own after delivery.
Diagnosis & Tests
In most cases, a doctor will diagnose folliculitis based on the appearance of the skin. A detailed medical history of the patient may help the doctor identify the event or agent that triggered the condition. If the rash is recurrent or does not respond to the traditional treatments, the doctor may choose to culture a sample of the pus or hairs from the affected area to determine the specific organism causing the infection.
In rare cases, a skin biopsy may be used to confirm the diagnosis and rule out other conditions. It is possible for folliculitis to be misdiagnosed since many of the symptoms mimic other conditions, including diaper rash, heat rash, scabies, contact dermatitis, or even an allergic reaction.
Treatment & Therapy
Self-care measures are often sufficient for mild cases of folliculitis and include:
- Warm compresses applied to the area several times a day can relieve discomfort and promote draining.
- Oatmeal lotions and over-the-counter hydrocortisone creams can alleviate itching.
- Washing the affected area twice a day with an antibacterial soap or wash can prevent the infection from spreading. It is important not to share wash clothes or towels with other family members and to wash them in hot soapy water to avoid spreading the infection.
- Avoid shaving the affected area.
A number of options are available for the treatment of folliculitis that does not respond to self-care therapies. Topical antibiotic creams, such as mupirocin, are typically used for mild infections. As a general rule, oral antibiotics are only used if the folliculitis is severe, recurrent, or if a systemic infection is suspected. Antifungal creams, pills, or shampoos are prescribed if the folliculitis is caused by yeast since antibiotics are not effective in treating these types of infections.
Depending on the type of folliculitis, the doctor may also prescribe oral or topical steroids to reduce inflammation. If the infected follicle develops into a boil or carbuncle, the doctor may have to drain the pus using a small incision. This can help alleviate pain and reduce the chances of scarring.
Limited studies have shown that light therapy along with a medicated cream may help some patients with folliculitis that did not respond to other treatments. Laser hair removal can help clear up infections and lessen hair density, which can prevent further ingrown hairs and infections. Laser treatments can be expensive and can cause side effects, including scarring, blistering, and skin discoloration.
Prevention & Prophylaxis
It is also important to use a moisturizing lotion after every shave. Men with barber’s itch may want to consider skipping shaving altogether or using a depilatory or another method of hair removal. Other tips for preventing folliculitis include:
- Avoiding tight clothing.
- Allowing rubber gloves to dry out thoroughly between uses.
- Avoid using pools and hot tubs unless it is clear that they are properly cleaned and chlorinated.