Folliculitis Treatment

Overview
With common names like hot tub folliculitis and barber's itch, folliculitis may sound more like a bad joke than a skin disorder. But folliculitis, an infection of the hair follicles, is no laughing matter. Severe cases may cause permanent hair loss and scarring, and even mild folliculitis can be uncomfortable and embarrassing.

Folliculitis usually appears as small, white-headed pimples around one or more hair follicles — the tiny pockets from which each hair grows. Most infections are superficial, and they may itch, but on occasion they're painful.

Superficial folliculitis often clears by itself in a few days, but deep or recurring folliculitis may need medical treatment.

The signs and symptoms of folliculitis vary, depending on the type of infection. In forms of the disorder that affect the upper part of the hair follicle (superficial folliculitis), signs and symptoms include:

Clusters of small red bumps that develop around hair follicles

Pus-filled blisters that break open and crust over

Itchiness or tenderness

Deep folliculitis starts deeper in the skin surrounding the hair follicle and affects the entire hair follicle. Signs and symptoms of deep folliculitis include:

A large swollen bump or mass

Pus-filled blisters that break open and crust over

Pain

Possible scars once the infection clears

Superficial folliculitis
Superficial forms of folliculitis include:

Staphylococcal folliculitis. This common type of folliculitis is marked by itchy, white, pus-filled bumps that can occur anywhere on your body. When it affects the beard area of men, it's called barber's itch. It occurs when hair follicles become infected with Staphylococcus aureus (staph) bacteria. Although staph bacteria live on your skin all the time, they generally cause problems only when they enter your body through a cut or other wound. This can occur through shaving or with an injury to the skin.

Pseudomonas folliculitis (hot tub folliculitis). The pseudomonas bacteria that cause this form of folliculitis thrive in a wide range of environments, including hot tubs whose chlorine and pH levels aren't well regulated. Within eight hours to five days of exposure to the bacteria, a rash of red, round, itchy bumps will appear that later may develop into small pus-filled blisters (pustules). The rash is likely to be worse in areas where your swimsuit holds contaminated water against your skin. You're at increased risk of infection if you have diabetes, a history of skin infections, or open cuts or sores.

Tinea barbae. Caused by a fungus rather than a bacterium, this type of folliculitis develops in the beard area in men, causing itchy, white bumps. The surrounding skin also may become reddened. A more serious, inflammatory form of the infection appears as pus-filled nodules that eventually form a crust and that may occur along with swollen lymph nodes and fever.

Pseudofolliculitis barbae. An inflammation of the hair follicles in the beard area, pseudofolliculitis barbae affects men with curly beards. It develops when shaved hairs curve back into the skin, leading to inflammation and, in rare cases, to dark raised scars (keloid scars) on the face and neck.

Pityrosporum folliculitis. Especially common in young and middle-aged adults, pityrosporum folliculitis produces chronic, red, itchy pustules on the back and chest and sometimes on the neck, shoulders, upper arms and face. It's caused by the yeast-like fungus.

Herpetic folliculitis. Shaving through a cold sore — a small, fluid-filled blister caused by the herpes simplex virus — can sometimes spread the herpes infection to neighboring hair follicles.

Deep folliculitis
Types of deep folliculitis include:

Gram-negative folliculitis. This sometimes develops in people receiving long-term antibiotic treatment for acne. Antibiotics alter the normal balance of bacteria in the nose, leading to an overgrowth of harmful organisms (gram-negative bacteria). In most people, this doesn't cause problems, and the flora in the nose returns to normal once antibiotics are stopped. In a few people, however, gram-negative bacteria spread to the cheeks, chin and jaw line, where they cause new, sometimes-severe acne lesions.

Boils 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 about 1/2 inch in diameter. The surrounding skin also may be red and swollen. Within 24 hours, the bump fills with pus. It grows larger and more painful for five to seven days, sometimes reaching golf ball size before it develops a yellow-white tip that finally ruptures and drains. Boils generally clear completely in about two weeks. Small boils usually heal without scarring, but a large boil may leave a scar. A carbuncle is a cluster of boils that often occurs on the back of the neck, shoulders or thighs, especially in older men. Carbuncles cause a deeper and more severe infection than does a single boil. As a result, they develop and heal more slowly and are likely to leave scars.

Eosinophilic folliculitis. Seen primarily in HIV-positive people, this type of folliculitis is characterized by recurring patches of inflamed, pus-filled sores, primarily on the face and sometimes on the back or upper arms. The sores usually spread, may itch intensely and often leave areas of darker than normal skin (hyperpigmentation) when they heal. The exact cause of eosinophilic folliculitis isn't known, although it may involve the same yeast-like fungus responsible for pityrosporum folliculitis.

 

Causes of Foliculitis

Every hair on your body grows from a follicle, a small pocket of modified skin. Although follicles are densest on your scalp, they occur everywhere except your palms, soles and mucous membranes, such as your lips.

Each follicle is attached to a small muscle. When you're cold or frightened, the muscle contracts, raising the hairs above the level of your skin and giving the appearance of goose bumps. Just above these muscles are sebaceous glands that produce an oil (sebum) that lubricates your skin and coats each hair shaft. Sebum is carried to the follicles and skin in tiny ducts.

Normally, the follicles carry out these functions with few problems. But when they're damaged, they may be invaded by viruses, bacteria or fungi, leading to infections such as folliculitis.

The most common causes of hair follicle damage include:

Friction from shaving or tight clothing

Excessive perspiration

Inflammatory skin conditions, including dermatitis and acne

Injuries to your skin, such as abrasions or surgical wounds

Covering your skin with plastic dressings or adhesive tape

Exposure to coal tar, pitch or creosote — common among roofers, mechanics and oil workers

Risk Factors Leading to Foliculitis

Anyone can develop folliculitis, but certain factors make you more susceptible to the condition. These include:

Medical conditions that reduce your resistance to infection, such as diabetes, chronic leukemia, organ transplantation and HIV/AIDS

A pre-existing skin condition, such as acne or dermatitis

Trauma to your skin from surgery

Long-term antibiotic therapy for acne

Topical corticosteroid therapy

Obesity — folliculitis is more common in people who are overweight

Living in a warm, humid climate

 

Mild cases of folliculitis often clear up without any treatment. But if the infection doesn't improve in two or three days, appears to spread or recurs often, call your doctor or a dermatologist. You may need antibiotics or antifungal medications to help control the problem.

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