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/ EDUCATION / MAYO CLINIC HEALTH LIBRARY / ARTICLE

DISEASES AND CONDITIONS

Folliculitis
Updated: 3/8/2018

Overview

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.

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Symptoms

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

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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.

Causes

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.

Risk factors

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

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• 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

Complications

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

Prevention

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

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• 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.

Diagnosis

Your doctor is likely to diagnose folliculitis by looking at your skin and

reviewing your medical history. He or she may use a technique for
microscopic examination of the skin (dermoscopy).

If initial treatments don't clear up your infection, your doctor may use a swab
to take a sample of your infected skin or hair. 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.

Treatment

Treatments for folliculitis depend on the type and severity of your condition,
what self-care measures you've already tried and your preferences. Options
include medications and interventions such as laser hair removal. Even if
treatment helps, the infection may come back.

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Medications

• Creams or pills to control infection. For mild infections, your doctor

may prescribe an antibiotic cream, lotion or gel. 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. 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 to ease the
itching. 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 carbuncle, your doctor may
make a small incision in it to drain the pus. This may relieve pain, speed
recovery and lessen scarring. Your doctor may then cover the area with
sterile gauze in case pus continues to drain.
• Laser hair removal. If other treatments fail, long-term hair removal
with laser therapy may clear up the infection. This method is expensive
and often requires several treatments. It permanently removes hair
follicles, thus reducing the density of the hair in the treated area. Other
possible side effects include discolored skin, scarring and blistering.

Lifestyle and home remedies

Mild cases of folliculitis often improve with home care. The following
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.

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• Apply soothing lotions. Try relieving itchy skin with a soothing 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, stop shaving, as most cases of barber's itch
clear up a few weeks after you stop shaving.

Preparing for an appointment

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?

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• 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.

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