You are in a hurry to go to work in early morning and you are shaving a bit urgently, then suddenly there is a nip from the razor. You just apply some antiseptic lotion and move about your usual day, you return from work and find that the nip has turned into a nasty little red bump and the red bumps have spread to other parts and has become painful. This is what is called folliculitis, that is, inflammation of the hair follicle due to infection of bacteria, virus, fungi etc. It is a common skin condition which is not life threatening or serious and easily treatable but can be sore, itchy and embarrassing.
What Is Folliculitis?
A common skin condition in which hair follicles gets inflamed is known as folliculitis. Initially it looks like red bumps or white headed pimples around hair follicles. Infection can spread and become non-healing and hard sores. Common causes of folliculitis are bacterial or fungal infection. ‘Follicle’ is a small hole or sac which is a part of skin where hair grows and into this sac, sebaceous glands open. “Itis” means inflammation (redness and swelling).
Apart from bacterial or fungal infection, inflammation may also occur due to viral infection, inflammation from ingrown hairs, irritation by clothes, chemical substances, razors, waxes etc. Common bacterial infection is caused by Staphylococcus aureus that present on the skin, but cause swelling and redness of hair follicles when they get into the body through cuts. Hot tub baths may also cause folliculitis because of infection of bacteria called pseudomonas folliculitis present in hot tub.
Where Does Folliculitis Occur?
Folliculitis occurs in areas of the body where hair follicles are present. The most common areas where it occurs is scalp where follicles are densest, face, chest, back, thighs, buttocks and groin area. It does not occur in mouth, eye lids, palm and soles of feet as these areas are devoid of hair follicles.
How Does Folliculitis Look Like?
Folliculitis shows acne-like appearance. There are small red bumps on the skin. They may have white heads on them.
What Are The Symptoms Of Folliculitis?
- The affected area appears as a cluster of small red bumps or white heads around the hair follicles
- It may form into pus-filled blisters which may break and ooze pus
- Burning sensation in the affected area
- Itchy skin
- Large swollen bump
- There may be itchiness surrounding the affected area
- Pain in the affected area and tender skin
What Are The Types Of Folliculitis?
There are mainly two types of folliculitis, namely
- Superficial folliculitis
- Deep folliculitis
Superficial folliculitis involves only a part of follicle whereas deep folliculitis involves almost the entire follicle. Superficial folliculitis has acute onset, that is, sudden onset. It may occur due to razor cut during shaving or small cuts and abrasions.
Deep folliculitis is chronic in nature (present for long time) and it may be more severe and painful requiring longer time to heal and cause scarring.
What Are The Types Of Superficial Folliculitis?
- Bacterial Folliculitis : Staphylococcus bacteria are present on our skin all the time. These bacteria enter the body through small cuts or wounds and cause infection of the hair follicles causing bacterial folliculitis. They may cause itching and may become filled with pus.
- Pseudofolliculitis Barbae : It is also called razor bumps. This type of folliculitis is seen during shaving facial hair, when men shave too close or in women who get waxing done in sensitive areas like groin.
- Pseudomonas Folliculitis (Hot Tub Folliculitis) : This type of folliculitis is caused by Pseudomonas bacteria which is present in hot tubs and heated swimming pools where chlorine and pH levels are not properly regulated. It is seen as red, itchy round bumps after one to two days of exposure to bacteria.
- Pityrosporum Folliculitis : This is caused due to yeast infection. It occurs in the back, chest, arms, neck, shoulders, face and seen as red itchy pustules.
What Are The Types Of Deep Folliculitis?
- Sycosis Barbae : This is usually superficial but also becomes deep when the deeper part of hair follicle gets infected. It affects males who have started to shave.
- Gram-negative Folliculitis : This type occurs in persons receiving long-term antibiotic treatment for acne.
- Boils (carbuncles and furuncles) : This type of folliculitis occurs due to deep infection of hair follicles by Staph bacteria and seen as red or pink painful raised bump.
- Eosinophilic Pustular Folliculitis (Epf)
This type of folliculitis occurs due to disorganized immune system. The follicular pustules are seen on back, face and chest areas. The different types of EPF are:
- Infantile Eosinophilic Folliculitis : This occurs within 24 hours of baby being born and may last up to 3 years. It is seen on scalp, neck, face as recurrent pustules.
- HIV-Associated EPF : Occurs in HIV-positive patients who have decreased immunity.
- Medication Associated EPF : Occurs in patients taking antibiotics, hormones, steroids.
- Cancer-Associated EPF : Occurs in cancer patients due to immune suppression.
- Classic EPF : First seen in Japanese population, now seen in other races also and the cause is not known.
What Is Razor Burn Folliculitis?
- Razor burn folliculitis occurs in men on the neck while shaving.
- It occurs in women on legs while shaving. It occurs when repeatedly razor is passed on the area which causes tiny cuts and this allows the bacteria to enter the skin and infect the deeper hair follicles. It also occurs in women during waxing.
What Is Scarring Scalp Folliculitis?
It is a very rare form of folliculitis which is inflammatory and may cause permanent hair loss.
What Is Viral Folliculitis?
This occurs due to virus infection by herpes simplex virus, affects lips and face, called cold sore.
Is Folliculitis Infectious Or Contagious, Does It Spread From One Person To Another?
Folliculitis is not contagious generally speaking. It does not spread from one person to another by touch, but the bacteria causing the folliculitis can be infectious. For example, sharing the razor, towels or clothes of the person affected by folliculitis may cause the other person also to have folliculitis. Persons using Jacuzzi or bath tubs of affected people can be affected by folliculitis.
Folliculitis can be diagnosed by physical examination of skin. Sometimes microbial culture may help in the diagnosis of folliculitis. Infected hair can be examined under microscope to detect fungal infection. Skin biopsy may also be done for diagnosing folliculitis.
What Is The Treatment For Folliculitis?
Folliculitis is seen in people who may not have any other disease or illness. Most cases of folliculitis clears up on its own without treatment in few days and others are easily treatable with over-the-counter medications like benzoyl peroxide, chlorhexidine. Antibiotics or antifungal creams can be applied on the affected area depending on the type of folliculitis. Steroid cream helps reduce inflammation.
How Do You Get Rid Of Folliculitis At Home?
- Keep the area clean by washing with antibacterial soap
- Use warm salt water-put 1 teaspoon of salt mixed with 2 cups water on a washcloth and apply to the affected area
- You can use over-the-counter gels, creams
- Avoid shaving the affected area until the folliculitis clears up
- Apply cold packs, ice packs to soothe the skin
- Do not pick on the affected area as it may result in scarring
What Is The Best Antibiotic For Folliculitis?
- Topical antibiotic cream like clindamycin or metronidazole can be applied twice daily on the affected area. This treats the mild to moderate types of bacterial folliculitis.
- More severe types are treated with oral antibiotic regimen of cephalexin, doxycycline, minocycline or levofloxacin.
How Is Fungal Folliculitis Treated?
Fungal folliculitis or folliculitis due to yeast infection and is treated with antifungal washes like ketoconazole (Nizoral) shampoo. Deeper fungal folliculitis can be treated with miconazole (Lotrimin) or terbinafine (Lamisil) or fluconazole (Diflucan).
Folliculitis is a common skin condition, so anyone can get this, but certain conditions make people more susceptible to folliculitis.
- Person with curly hair who shave
- Person suffering from dermatitis/Acne
- Using public hot tubs
- Wearing tight clothing
- Certain medical conditions such as HIV/AIDS, diabetes, chronic leukemia etc. weaken immune system and make susceptible to infection.
Read more on Infected Ingrown Hair
There are very rare complications and very infrequent ones as it is a self-limiting condition. The infected bumps may form abscess (filled with pus) and cysts that might require drainage. Rarely might it lead to cellulitis. The affected area may become discolored after a few days. Other complications include
- Recurrent infection
- Spreading of infection
- Permanent hair loss
- Boils formation under the skin
- Dark spots or scarring cause permanent skin damage
- Hair follicle destruction
How Do I Prevent Folliculitis?
- Maintain proper skin hygiene
- Avoid tight clothes
- Do not share razors, towels or clothes
- Do not share bath tubs
- Avoid shaving sensitive areas or else shave with care
- Use skin removal products
- Keep the skin well hydrated by drinking plenty of water
- Dry rubber glove between uses
When Do I Visit My Doctor?
- Usually folliculitis limits on its own and will disappear in a few days, but there are other skin conditions which are similar to folliculitis with the same kind of signs and symptoms. Hence, it is difficult to distinguish between folliculitis and other skin conditions.
- If the red bumps do not decrease after a few days of home remedies or over-the-counter lotions or creams, it would be better to visit your doctor to find out whether you are suffering from any other skin condition.
Folliculitis is an easily treatable condition. There are no potential complications from this. This does not indicate any underlying systemic condition; it is just a condition of the skin. The only worry for some people might be that it will not be aesthetically pleasing to you until it clears off by itself or by medication.