Bacterial Folliculitis

1. Staphylococcal folliculitis
Bockhart impetigo”. It is caused by the bacterium, staphylococcus aureus, and presents as
pustules (most often without symptoms of fever). A person who develops folliculitis as a
result of this bacterium is more often than not a chronic carrier (i.e. the bacterium is present
in the system but does not present noticeable symptoms). For the most part, this bacterium
is generally present on the skin but typically becomes problematic once it has entered the
body via a wound (like a cut or open sore). For some, this is how they become a carrier.

A common form of bacterial folliculitis is barber’s itch, also known as pseudofolliculitis

barbae (razor bumps / razor-burn folliculitis) which affects men with particularly course and
curly beard hairs. When these hairs are cut short while shaving, regrowth tends to curve
back into the skin causing ingrown hairs and resulting in inflammation, especially on the
neck. Excessive close shaving can also trap small hairs beneath the surface of the skin,
resulting in inflammation. Tiny cuts which occur during shaving allow opportunity for
bacterial entry, causing damage to hair follicles.
This type of razor-burn folliculitis may also affect women who shave their legs. Those who
frequently go for bikini waxes can also experience this form of folliculitis, but in their groin
area. Dark, raised scars (keloids) can occur in either instance.

2. Gram-negative folliculitis
A variety of gram-negative bacteria cause this condition, each with their own symptoms.
One of the most common forms is hot tub folliculitis (or pseudomonas folliculitis), as a result
of an infection with pseudomonas aeruginosa bacterium. The name stems from the most
likely source of contraction, inadequately sanitised spa baths or hot tubs, as well as heated
pools with unregulated chlorine and pH levels. Red spots (without pus) and pustules which
appear within 72 hours are common symptoms of this type of folliculitis. Aeromonas
hydrophila bacterium may also cause folliculitis if you are exposed to it during recreational
water activities.

A rare acne-like condition due to infection with Enterobacter, Klebsiella or Proteus gram-
negative bacteria may occur in those with rosacea or acne vulgaris (2) as a direct result of
long-term antibiotic treatment for these conditions. Eruptions are common in the facial area
and present as pustules or pus-filled cysts (in 20% of patients), which normally clear once
treatment has been discontinued.
Fungal Folliculitis
Second to S.Aureus bacteria, fungi are common culprits in the development of folliculitis.

1. Dermatophyte folliculitis
This form of the condition is caused by one of three types of fungus, namely the
Epidermophyton, Microsporum or Trichophyton species. A fungal infection of the scalp
affecting the hair follicles on the head commonly causes tinea capitis (or ringworm of the
scalp) while this type of infection involving the beard and moustache is referred to as tinea
barbae. 
2. Malassezia (Pityrosporum) folliculitis
Many of the Malassezia species cause folliculitis. These yeasts occur naturally on the skin of
health individuals and form part of the natural skin florae. Colonisation is exacerbated due
to increased sebaceous gland activity (especially during adolescence), warm, humid climates
and occasionally certain medication use (antibiotics, corticosteroids or
immunosuppressants). 
3. Candida folliculitis
Another opportunistic yeast pathogen, candida albicans can also provoke a folliculitis
breakout within skinfolds or along the beard area of the face. 
Viral folliculitis
1. Herpes folliculitis
This form of folliculitis is rare, and usually attributed to an infection with the varicella zoster
virus (VZC). However, the herpes simplex viruses (HSV-1 or oral herpes and HSV-2 – genital
herpes) can sometimes lead to a folliculitis breakout, most commonly in men with localised
infections, which is also aggravated by shaving. The herpes zoster virus (responsible for
shingles) and molluscum contagiosum can also lead to the formation of folliculitis pustules
or papules (and crusted spots).

Demodex folliculitis
A microscopic hair follicle mite called demodex can lead to demodex folliculitis. Symptoms
are clinically similar to that of another inflammatory skin condition, called rosacea. This
form of folliculitis is most common among those with suppressed immune systems (which
can occur due to a medical condition or as a side-effect of medication used for medical
treatment). 
Scabies, a highly contagious and itchy skin condition which develops due to an infestation of
mites (Sarcoptes scabiei) can also provoke folliculitis symptoms (bumps), along with papules
(swelling on the skin / small pimple), and vesicles (small fluid-filled cyst).