Folliculitis

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Introduction

What is folliculitis?

Folliculitis is the term used to describe superficial skin inflammation of one or more hair follicles anywhere in the skin. The disorder is caused by damage to the follicles, by a blocked follicle, by shaving, or by friction caused by clothing, helmet straps, and the like. Hair follicles in the neck, groin, or genital area are particularly susceptible to inflammation. The damaged follicle is most frequently infected with staphylococcal bacteria when infection is present. Contaminated hot tubs are another common source of infectious folliculitis (pseudomonas folliculitis).

Folliculitis can also occur if a curly facial hair is shaved too closely and irritates the skin. This second form of folliculitis is caused by a section of the hair shaft that has been pressed or grown back into the skin. Both types of folliculitis occur mostly in men; the second form is especially prominent in African American men.

Other types of folliculitis include pityrosporum folliculitis, herpetic folliculitis, gram-negative folliculitis, pseudomonas folliculitis, eosinophilic folliculitis, and tinea barbae.

Folliculitis is not a serious condition, but it does require prompt attention if the area becomes infected or if the infection spreads. Seek prompt medical care if, after home treatment, symptoms recur frequently, if they persist for more than two or three days, or if the infection spreads.

Symptoms

What are the symptoms of folliculitis?

Symptoms of folliculitis include an itchy skin rash with pimples or pustules developing near a hair follicle. These most frequently appear in the neck, groin, or genital areas. In some cases, the pimples may develop a crust.

Symptoms of folliculitis

You may experience folliculitis symptoms once in a while after a minor injury, but they should resolve on their own within two or three days. Symptoms include:

  • Itchy or tender skin at the hair follicle
  • Red bumps around a follicle
  • Redness and inflammation

Symptoms of deep folliculitis

When the inflammation spreads deeper into the skin around the follicle, symptoms include:

  • Large bump
  • Possible scarring
  • Pus-filled blisters that ooze and crust
  • Swelling

Serious symptoms that might indicate a life-threatening condition

Folliculitis is not a serious condition, but left untreated, a staph infection (an infection caused by staphylococcal bacteria) can sometimes enter the bloodstream and spread, resulting in a systemic infection called bacteremia or sepsis that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness
  • Confusion or loss of consciousness for even a brief moment
  • Severe difficulty breathing, which may be accompanied by pale or blue lips, rapid heart rate (tachycardia), and anxiety
  • Severe pain

Causes

What causes folliculitis?

Folliculitis is caused by damage to the hair follicles due to clothing (especially rough fabrics such as wool), helmet straps, or other objects rubbing against the hair or beard. Folliculitis can also develop from a blocked follicle or as a result of shaving.

Shaving can cause two different types of folliculitis: either a staph infection (an infection caused by staphylococcal bacteria) that is usually in the beard area and is called barber’s itch; or inflammation caused by a short facial hair that has curved and grown back into the skin. This second form is called pseudofolliculitis barbae. Both forms of folliculitis occur mostly in men and are aggravated by shaving.

Other causes of folliculitis include herpes infection (herpetic folliculitis), adverse reaction to long-term antibiotic therapy for acne (gram-negative folliculitis), hot water from hot tubs or heated swimming pools (pseudomonas folliculitis), and fungal infection (tinea barbae). Eosinophilic folliculitis, which is characterized by an itchy rash, has no known cause.

What are the risk factors for folliculitis?

A number of factors increase the risk of developing folliculitis. Not all people with risk factors will get folliculitis. Risk factors for folliculitis include:

  • Any medical condition that increases your risk of infection
  • Exposure to hot water, especially in hot tubs or heated swimming pools
  • Exposure to topical corticosteroids
  • Preexisting skin conditions
  • Trauma to your skin

Reducing your risk of folliculitis

You may be able to lower your risk of folliculitis by:

  • Avoiding friction from too-tight clothing
  • Changing razors or razor blades after every use
  • Keeping your razor clean
  • Keeping your skin clean, especially after exercising, sweating, or using hot tubs or heated swimming pools
  • Managing your weight
  • Minimizing trauma while shaving
  • Using mild soaps and skin creams, preferably perfume-free

Treatments

How is folliculitis treated?

Mild cases of folliculitis are self-limiting and usually resolve within two to three days. If the condition persists or recurs or if infection sets in, you may need medications specific to the type of infection. It is important to take the full course of treatment for any infection or the infection may recur, worsen or spread as soon as treatment stops.

Medications for severe or persistent folliculitis

Some treatments for severe or infectious folliculitis include oral or topical antibiotics, oral or topical antifungal agents, oral antiviral medications, oral antihistamines, or topical corticosteroids. Treatment choices depend on the type and severity of your disorder and include:

  • Antibiotics, such as erythromycin (E-mycin, Ery-Tab), tetracycline (Acrymycin V, Sumycin), or dicloxacillin (Dynapen)
  • Antifungal agents such as terbinafine (Lamisil, Lotrimin, Nizoral)
  • Antihistamines for itching, such as ceterizine hydrochloride (Zyrtec), diphenhydramine (Benadryl), fexofenadine (Allegra), and loratadine (Claritin)
  • Antiviral agents, such as valacyclovir (Valtrex), acyclovir (Zovirax), and famciclovir (Famvir)
  • Topical corticosteroids, such as hydrocortisone cream (Cort-Dome, Dermacort, Hytone, Synacort), betamethasone dipropionate (Diprosone), flurandrenolide (Cordran), fluticasone propionate (Cultivate), and triamcinolone acetonide (Aristocort, Kenalog). High- and very high-strength corticosteroids include betamethasone dipropionate (Diprosone, Diprolene), fluocinonide (Lidex), triamcinolone (Kenalog), and clobetasol propionate (Temovate)

What you can do to improve your folliculitis

Most cases of folliculitis resolve by themselves within two to three days. Whether you are being treated with medication or not, you can also prevent or limit folliculitis outbreaks by:

  • Managing your weight
  • Switching to an electric shaver or changing razor blades after every use
  • Switching to mild soaps and skin creams, preferably perfume-free
  • Washing your skin thoroughly after exercising, sweating, or using hot tubs or heated swimming pools
  • Wearing loose clothing as much as possible

What are the potential complications of folliculitis?

Complications of untreated or poorly controlled folliculitis can be serious in rare instances. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of folliculitis include bacterial infections, which, left untreated, can lead to sepsis in rare cases.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
  1. Folliculitis. Medline Plus, a service of the U.S. National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000823.htm.
  2. Folliculitis. American Osteopathic College of Dermatology. http://www.aocd.org/skin/dermatologic_diseases/folliculitis.html.
  3. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 2005; 41:1373.
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