Folliculitis

What is folliculitis?

Folliculitis is a common skin disorder caused by an inflammation of the hair follicles that is characterised by small, red, inflamed pimples on the skin.

The most common cause of folliculitis is bacterial infection, usually Staphylococcus aureus (staph). Fungal  and viral infections can also cause folliculitis, but less commonly so. Any part of the body, (with exception to the palms of the hands and soles of the feet, that don't contain hair follicles) can become affected, but common areas include the face (in men who shave), scalp, arms, legs, armpits, chest, back and buttocks. It may be classified as superficial folliculitis, affecting only the top layer of the skin or deep folliculitis, penetrating into the deeper layers.

Causes of folliculitis:

Folliculitis occurs when the hair follicle is damaged or blocked, leading to inflammation. This in turn can cause the follicle to become more prone to infection. Folliculitis causes fall into four categories; bacterial, fungal, viral & non-infectious.

Common predisposing factors include;

• Tight clothing.
• Nappies.
• Hot/humid conditions.
• Diabetes.
• Excessive sweating.
• Poor personal hygiene.
• Topical steroid use.
• Weakened immune system such as in people with HIV, cancer, transplant patients, poorly controlled diabetes.
• Exposure of the skin to certain chemicals.
• Shaving
• Hot tubs are a known source of what is commonly called hot-tub folliculitis. In this case, the bacteria responsible are Pseudomonas aeruginosa.

Types of folliculitis:

Barber's itch/Barbers rash: Folliculitis appears on the bearded facial areas, especially above the upper lip. It is usually caused by Staphylococcus aureus.

Tinea barbae is another form of folliculitis of the bearded area. This is caused by a fungus.

Gram negative folliculitis can occur after long term antibiotic use for the treatment of acne.

Herpetic folliculitis is caused by a cold sore on the face being broken during shaving & spreading to neighbouring hair follicles.

Eosinophilic folliculitis (EF) - Most commonly seen in people with an immune deficiency and is characterised by itchy, papules usually found on the upper body. The affected area is extermely itchy.

Pityrosporum folliculitis (PF) - Caused by a yeast, most commonly Malassezia furfur, pityrosporum folliculitis is seen most often in teenagers. Commonly affected areas are the back, chest, upper arms, neck and face.

Pseudofolliculitis barbae (PFB) - Also known as Barber's Itch or razor bumps, pseudofolliculitis barbae is most commonly found on the male face, especially African/American men. It is a condition which occurs when a cut hair grows back into the skin

Pseudomonas folliculitis (Hot tub folliculitis) - As the name would suggest, this form of folliculitis is caused by bacterial infection caused hot tub use. In this case, the bacteria responsible are Pseudomonas aeruginosa.

Styes are inflammation of the hair follicle on the eyelash.

Folliculitis symptoms:

The most common symptom of folliculitis is clusters of small, inflamed, pimples or pustules (approximately 1mm to 5mm wide) around the hair follicles. Pimples may come to a head, burst and then scab over. Not all pimples will form a head. Other symptoms include;

• Mild pain and itching may also be present.

• Pain may be more severe with deep folliculitis.

• Hair may pull out easily from the affected follicles.

• Fever may be present with some types of folliculitis.

• Hair loss and scarring can occur as a result of folliculitis. In some cases, complications may arise, including boils, abscesses, furuncles, carbuncles and cellulitis. If you suspect you have folliculitis, see your GP for a diagnosis. There are other skin disorders with very similar symptoms.

• Intense itching in areas underneath the bathing suit with hot tub folliculitis.

Deep folliculitis symptoms are similar, but pustules are larger, more painful & may leave scars once the folliculitis clears.

Folliculitis treatment:

Mild cases of superficial folliculitis may not require any treatment, it usually clears on it's own in 7-10 days.  Deep or recurring folliculitis will require medical treatment.

Antibacterial cleansers - Over the counter antibacterial cleansers applied to affected areas.

Antibiotics - Over the counter antibiotic cream to apply to affected areas. More severe cases may require oral antibiotics.

Warm compress - To help bring pustules to a head.

Acyclovir or famciclovir - To treat herpatic folliculitis.

Anti-fungal medications (topical or oral) - For fungal infections such as Pityrosporum folliculitis and Tinea barbae.

Preventing folliculitis:

Good personal hygiene is important. Regular washing with soap & not forgetting to shampoo the hair regularly.

Don't share razors, towels etc.

Avoid spas that have not been maintained properly.

Avoid wearing tight fitting clothing.

Don't shave against the grain of hair growth.

Is folliculitis contagious?

In some cases yes. Therefore it is important not to share towels, razors etc.

Also see:

Athletes foot, Cellulitis, Cold Sores, Corns, Dyshidrotic Eczema, Eczema, Flea bites, Folliculitis, Impetigo, Itching, Itchy Scalp, Jock Itch, Molluscum contagiosum, Nappy rash, Nummular Eczema, Prickly Heat, Psoriasis, Ringworm, Rosacea, Roseola, Scabies, Tinea Capatis, Tinea Versicolour, Vitiligo, Warts

Please note:

The medical articles on this site have not been written by a doctor & should not be considered a replacement for a doctor visit. The articles are provided for informative purposes only.

Always seek immediate medical advice for any problems.

While great care has been made in the creation of these articles, we cannot guarantee the accuracy or omissions on these pages. If in any doubt whatsoever, seek professional medical advice.