What is folliculitis?
Folliculitis is a common skin condition in which hair follicles become inflamed. It appears as small, red, pimple-like bumps on the skin that surround hair follicles. These bumps may be itchy, painful, or both. Folliculitis can occur anywhere hair follicles are present, including the scalp, face, legs, arms, and groin.
Folliculitis occurs when bacteria, fungi, or viruses infect the hair follicle, most often due to damaged skin. Things that damage the skin and allow germs to enter the follicle include shaving, waxing, tight clothing, friction from clothing, occlusion from bandages or tape, scratching, and skin conditions like acne or eczema. Once the germ has entered the follicle, inflammation results as the body tries to fight off the infection.
There are several types of folliculitis:
– Bacterial folliculitis: This is the most common type, caused by Staphylococcus bacteria entering the follicle. It appears as clusters of small red bumps or white-headed pimples.
– Fungal folliculitis (tinea barbae): Caused by fungal infection in the beard area in men or scalp in anyone. Itchy red patches with small pustules may form.
– Pseudomonas folliculitis: Caused by Pseudomonas bacteria, often in hot tubs or pools with inadequate sanitation. Starts as small red bumps that develop into large, painful pus-filled bumps.
– Eosinophilic folliculitis: An inflammatory condition with unknown cause, usually affecting the face, back, and chest. Itchy red patches and pustules form.
– Barbers itch: Caused by staph bacteria around hair follicles irritated from shaving. Appears as itchy red bumps on the neck, cheeks, or scalp.
– Hot tub folliculitis: Caused by pseudomonas bacteria in inadequately chlorinated hot tubs and pools. Leads to an itchy rash of red bumps.
– Razor bumps: Not a true infection but inflammation from shaving irritating the hair follicles. Can become infected by staph bacteria.
What are the symptoms of folliculitis?
The main symptoms of folliculitis include:
– Small red bumps surrounding hair follicles
– Pus-filled bumps in more severe cases
– Itching or burning sensation
– Tenderness of the bumps
– Rash on areas of irritation, especially the scalp, face, legs, buttocks, armpits, beard area
– Flakiness, crusting, or scaling of the skin around bumps
– Hair loss in areas affected by scalp folliculitis
The appearance of the rash can vary depending on the type of germ causing infection. With bacterial folliculitis, small red bumps or white-headed pimples from pus will be present. Fungal folliculitis may appear as itchy red patches with small blisters or pustules.
Symptoms usually begin within a few days of skin irritation or injury that allows bacteria to enter the follicles. The rash can worsen over the following days or weeks if the infection persists. Symptoms are usually limited to the affected area of skin. Fever, chills, and other systemic symptoms are not typical unless the infection progresses.
Who is at risk for developing folliculitis?
While anyone can get folliculitis, some factors that put people at increased risk include:
– Shaving – especially in men who shave their faces daily
– Have frequent friction and occlusion of skin – like from tight clothing
– Have underlying skin conditions like acne, eczema, or psoriasis
– Recurrent rubbing or scratching of skin
– Have a weakened immune system – from illness or medications
– Exposure to hot tubs, pools, or whirlpools that are poorly sanitized
– Exposure to oils or greases at work
– Have diabetes, cancer, or are taking immunosuppressant drugs
People with frequent environmental exposure to bacteria or fungi are also more likely to develop folliculitis. Examples include pet owners, gardeners, and healthcare workers.
When to see a doctor about folliculitis
In most mild cases of folliculitis, the rash and bumps will resolve without medical treatment within 7-10 days as the body clears the infection. But it’s a good idea to see your doctor if:
– The rash is worsening or has not improved after 10-14 days of self-care
– The rash is very widespread or worsening quickly
– You develop a fever, flu-like symptoms, or skin redness extending beyond the bumps
– You have an underlying condition or take medications that weaken your immune system
– Bumps are becoming larger, more painful or filled with increasing amounts of pus
– Symptoms don’t resolve after a few courses of over-the-counter antibiotic creams or antifungal creams
– You get folliculitis frequently or it keeps coming back
Getting a proper diagnosis can ensure you get the right treatment to clear folliculitis that does not resolve on its own. People with very inflamed, painful, or recurring folliculitis may need oral antibiotic or antifungal pills to treat the infection. Those with weakened immune systems may need intravenous antibiotics.
How is folliculitis diagnosed?
Diagnosing folliculitis usually starts with a physical exam by your doctor. They will look closely at the rash and ask questions about your symptoms, including:
– When the rash began and if there was an event that preceded it (like shaving, new products used, or hot tub exposure)
– What the rash looks like – small bumps, pustules, itchy or not
– Where the rash is located and if it seems to be spreading
– If you have pain, burning, tingling or other sensations
– If you have had any other symptoms like fever or chills
– If the rash has gotten better or worse with self-care
– Your medical history, especially related to conditions like acne, eczema, or medications that cause immune suppression
The physical appearance of the rash gives clues about the type of folliculitis. Your doctor may also do a skin culture by lightly scraping some of the skin bumps. This sample can be sent to the lab to determine if bacteria, fungus, or other germs are present causing an infection.
A skin biopsy may be done in select cases if the rash is unusual or treatment resistant. This involves numbing the area, taking a small sample of the inflamed skin tissue, and sending to the lab to examine under a microscope.
Blood tests are not typically needed unless your immune system may be compromised. This helps identify any systemic factors making infections more persistent.
Can folliculitis be prevented?
It is difficult to prevent folliculitis completely, but you can reduce your risk by:
– Not sharing personal care items like razors, loofahs, or towels which may spread infection
– Maintaining good hygiene by washing regularly with antimicrobial soap and keeping skin moisturized
– Avoiding shaving with razors and opting for electric razors or hair removal creams if possible
– Using a new razor each time you shave
– Always shaving in direction of hair growth and not against it
– Avoiding scratching or picking at the skin
– Using topical benzoyl peroxide wash on body areas susceptible to folliculitis
– Avoiding constrictive clothing and clothing likely to cause friction on the skin
– Wearing loose-fitting breathable clothing like cotton
– Avoiding or limiting time in hot tubs, pools, and whirlpools
– Keeping hot tubs well-chlorinated and showering after use
– Treating any underlying skin conditions like eczema or acne
– Keeping chronic illnesses like diabetes under optimal control
Home treatment for mild folliculitis
In cases of mild or moderate folliculitis with limited bumps, you may be able to treat the rash at home with self-care measures:
– Do not scratch, pick at, pop, or shave over bumps as this can worsen infection
– Wash the area 1-2 times a day with an antibacterial soap like one containing benzoyl peroxide
– Apply a warm compress 2-3 times a day for 5-10 minutes to help soothe irritation
– Avoid irritating the skin with rubbing from clothing
– Avoid using oils, greases, or lotions on the affected area
– Apply an antibiotic ointment like bacitracin twice a day after washing
– Use an antifungal cream containing miconazole or clotrimazole if fungal folliculitis
– Take over-the-counter pain medication like acetaminophen (Tylenol) for discomfort
– Consider using hydrocortisone cream sparingly on very inflamed or itchy areas for no more than 5-7 days
– Wear loose-fitting cotton clothing while the rash resolves
It can take anywhere from 7-14 days for mild folliculitis to clear with self-care. See your doctor if it persists longer than this. Avoid using steroid creams for more than a week without medical oversight.
Medical treatment for folliculitis
For moderate or severe cases of folliculitis, targeted prescription antibiotic or antifungal treatment is usually needed.
*Bacterial folliculitis treatment*
– Oral antibiotics like dicloxacillin, cephalexin, or minocycline for 7-10 days
– Topical antibiotic washes, gels, creams with ingredients like clindamycin or erythromycin
– Benzoyl peroxide washes or leave-on creams
– Antibacterial soaps like chlorhexidine (Hibiclens)
– For severe or recurrent cases: Oral isotretinoin (high-dose vitamin A), dapsone
*Fungal folliculitis treatment*
– Oral antifungal like fluconazole or itraconazole for scalp fungal infections
– Topical antifungal creams like ketoconazole or selenium sulfide lotion
– Antifungal shampoos containing zinc pyrithione or ketoconazole
In those with a weakened immune system, intravenous antibiotics may be needed to treat widespread infection or resistance to oral antibiotics. Other advanced treatments like light therapy or isotretinoin pills may help severe, treatment-resistant folliculitis. Referral to a dermatologist is recommended in these difficult cases.
To prevent recurrent folliculitis after treatment, continue to practice good skin hygiene and avoid irritating activities like shaving or constrictive clothing as best as possible. Some people may need long-term antibiotic therapy. See your doctor if folliculitis keeps recurring frequently.
Home remedies and alternative treatments
Some natural remedies may help improve mild cases of folliculitis although there is limited research on their effectiveness. They should not replace medical treatment if the rash is severe or worsening.
– Tea tree oil – Apply diluted pure tea tree oil to bumps several times a day due to its anti-inflammatory and antimicrobial properties
– Aloe vera gel – Apply pure aloe vera to soothe irritation
– Honey – Apply manuka honey to bumps, which has antibacterial properties
– Turmeric paste – Make a paste with turmeric powder and water and apply to bumps
– Apple cider vinegar – Dilute apple cider vinegar with water and dab onto bumps with a cotton ball
– Warm compresses – Apply a warm cloth to the rash several times a day to encourage drainage
– Supplements like zinc or vitamin A/D – May support immune response against infection
– Probiotics – Can improve gut and skin health and immunity against germs
– Diet low in sugar/high in vegetables and anti-inflammatory foods
Avoid using any home remedies on severely inflamed or worsening rash. Seek medical treatment for extensive cases of folliculitis or those unresponsive to self-care.
Can folliculitis cause permanent scarring or hair loss?
In most cases of mild to moderate folliculitis, the bumps and rash will go away fully without leaving any scars once the infection resolves. However, more severe or persistent folliculitis can increase the risk of scarring or permanent hair loss.
Factors that make scarring more likely include:
– Picking at, scratching, or popping the follicular bumps which damages the tissue
– Very deep infection of the hair follicles
– Infection that forms abscesses or cysts around follicles
– Destruction of parts of the hair follicle structures
– Damage to the dermis layer of the skin during prolonged infection
– Severe inflammation that causes skin tissue injury
– Recurrent bouts of folliculitis in the same area
Any type of skin injury that damages the dermal layer can disrupt normal healing and lead to scarring. Follicles may be permanently destroyed.
Scalp fungal infections like tinea capitis have a higher risk of permanent hair loss if not treated early. Bacterial scalp folliculitis can also cause permanent bald patches when severe.
See your doctor promptly if you have any signs of deep infection like enlarging bumps, abscesses, oozing pus, or persistently worsening rash. Early treatment will minimize the chances of permanent damage to hair follicles and scarring.
What’s the outlook for people with folliculitis?
The outlook for folliculitis is generally very good, especially when treated early and appropriately. Mild cases often resolve on their own within 7-10 days. More significant cases may take 2-4 weeks to fully clear with medical treatment.
With proper antibiotic or antifungal therapy, most cases of fungal or bacterial folliculitis can be cured fully without complications. The rash and bumps should disappear without scarring. However, some people experience frequent recurrences or multiple episodes of folliculitis.
You have an excellent chance of curing folliculitis when you:
– Seek medical care for moderate/severe rash or any signs of worsening infection
– Take antibiotics or antifungals as prescribed without missing doses
– Identify and treat any underlying conditions or immune dysfunction
– Avoid picking at or irritating the skin before and during treatment
– Continue practicing good hygiene and skin care after the rash resolves
– Follow preventive steps between outbreaks like avoiding shaving and constrictive clothing
– See your doctor for early treatment when folliculitis recurs
With this approach, most people can successfully manage folliculitis and prevent permanent scarring or hair loss. Seek medical advice if you have frequent recurrences or difficulty getting folliculitis to clear.
Key points about folliculitis
– Folliculitis is an inflammation of hair follicles caused by bacterial, fungal, or viral infection
– It appears as small, red, sometimes itchy or pus-filled bumps surrounding hair follicles
– Risk factors include shaving, friction from clothing, acne, eczema, and immune dysfunction
– See a doctor for severe, worsening, or recurrent rash
– Mild cases may resolve in 1-2 weeks with self-care like antibacterial washes
– More significant cases need oral antibiotic or antifungal pills and advanced treatments
– Practice good hygiene and avoid skin irritants to prevent recurrences
– Prompt treatment can usually cure folliculitis fully without scarring or permanent hair loss