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Folliculitis

What Is Folliculitis?

Folliculitis is a common skin problem that happens when you get bacteria or a blockage in a tiny pocket in your skin called a hair follicle. You have hair follicles just about everywhere except your lips, your palms, and the soles of your feet. Folliculitis can make these hair follicles red and swollen.

You can get this condition anywhere you have hair, but it’s most likely to show up on your neck, thighs, buttocks, or armpits. You can often treat it yourself, but for more severe cases you may need to see your doctor.

Different kinds of folliculitis have other names you might have heard, such as:

  • Barber’s itch
  • Hot tub rash
  • Razor bumps
  • Shaving rash

Folliculitis Symptoms

Your symptoms will vary based on the exact type of folliculitis you have and how bad it is. You may have:

  • Groups of small red bumps like pimples, some with white heads on them
  • Blisters that break open, ooze, and become crusty
  • Large areas of red, swollen skin that may leak pus

These areas of your skin may be itchy, tender, and painful as well.

Types of Folliculitis

There are two primary types of folliculitis. Superficial folliculitis is when only part of the follicle is damaged, while deep folliculitis is when the whole follicle is damaged.

The main types of superficial folliculitis are:

  • Bacterial folliculitis: The most common form, this type causes itchy white bumps filled with pus. You can get it if you cut yourself and bacteria (usually staphylococcus aureus, also called staph) gets in.
  • Hot tub folliculitis (pseudomonas folliculitis): You can get this from swimming in a pool or sitting in a hot tub where pH or chlorine levels aren’t balanced. You’ll see a rash of red, round, itchy bumps a day or so after being in the water.
  • Razor bumps (pseudofolliculitis barbae): This type is caused by ingrown hairs linked to shaving or a bikini wax. You’ll have dark bumps, or keloids, on your face or neck after shaving or in your groin area after a wax.
  • Pityrosporum folliculitis: This type happens along with a yeast infection. It causes red, itchy, pus-filled pimples that show up on your upper body, mostly on your back and chest, but you can also have them on your neck, shoulders, arms and face.

Types of deep folliculitis include:

  • Sycosis barbae: This is when the whole follicle gets infected after shaving. It causes large red pus-filled bumps and can lead to scarring in some cases.
  • Gram-negative folliculitis: This type is caused by the use of long-term antibiotics to treat acne. It happens if the bacteria become resistant to the antibiotics and make the acne worse.
  • Boils and carbuncles: A boil (a red bump that can be tender or painful) happens when a hair follicle is seriously infected. A carbuncle is a cluster of several boils.
  • Eosinophilic folliculitis: This type typically affects babies or people who have a condition that affects their immune system. It causes itchy, pus-filled bumps that show up most often on the shoulders, upper arms, neck, and forehead.

Folliculitis Causes and Risk Factors

Staph , a kind of bacteria, is most often to blame. You have staph on your skin all the time, and it normally doesn’t cause any issues. But if it gets inside your body, say through a cut, then it can cause problems.

These other things can also cause folliculitis:

  • Blockages from skin products, such as moisturizers with oils
  • A fungus
  • Hair removal, such as shaving, waxing, and plucking
  • Ingrown hairs
  • Other bacteria, such as the kind you might find in a hot tub
  • Some drugs, such as corticosteroids that are used to ease inflammation

In general, you’re more likely to get the condition if you have damaged follicles. This can happen from things such as shaving, skin injuries, sticky bandages, and tight clothes. 

You also might be more likely to have folliculitis if you:

  • Have acne, especially if you use a steroid cream or long-term antibiotic for it
  • Are a man who has curly hair and shaves
  • Wear tight clothes, rubber gloves, or boots that don’t let sweat or heat out
  • Spend time in a pool or hot tub that’s not cleaned regularly
  • Have an illness that affects your immune system, like diabetes, leukemia, or HIV/AIDS

Folliculitis Diagnosis

Your doctor can usually tell if you have it by looking at your skin closely and asking questions about your medical history.

You don’t usually need tests unless treatments don’t work. In that case, your doctor may use a swab to take a skin sample and find out exactly what’s causing the problem.

Folliculitis Treatments

Mild folliculitis might go away without any treatment. To help yourself heal and ease symptoms, you can:

Clean the infected area: Wash twice a day with warm water and antibacterial soap. Be sure to use a fresh cloth and towel each time.

Use salt: Put warm saltwater -- 1 teaspoon table salt mixed with 2 cups of water -- on a washcloth and place it on your skin. You can also try white vinegar.

Gels, creams, and washes: Use over-the-counter antibiotics that you rub on your skin. If you’re itchy, you can try oatmeal lotion or hydrocortisone cream. It also helps to avoid shaving, scratching, and wearing tight or rough clothes on the infected area.

If these self-care treatments don’t work, your doctor may give you:

  • Antibiotic cream if the folliculitis is caused by bacteria (pills for very severe cases only)
  • Antifungal creams, shampoos, or pills if it’s caused by fungus
  • Steroid cream to help reduce swelling

Folliculitis Prevention

To lower your chances of getting folliculitis, your best bet is to stop shaving for at least 3 months, but for a lot of people that won’t do. You might want to try an electric razor or hair removal products (depilatories) or other ways to remove hair. If those don’t work for you, then be sure to:

  • Wash your skin with warm water and a gentle cleanser.
  • Apply plenty of gel or shaving cream, not soap, and let it sit 5-10 minutes to soften your hair.
  • Use a new blade each time you shave so you know it’s clean and sharp; single blades are ideal.
  • Shave in the direction your hairs grow.
  • Rinse with warm water and use moisturizing lotion.

It can help to shave only every other day. 

You also should not wear clothes that irritate your skin or trap heat and sweat, such as Lycra, rubber gloves, and high boots.

Limit your use of oils and other greasy skin products. They can cause blockages and trap bacteria. Other things you can do:

  • Dip into hot tubs only if you know for sure they are clean and well-maintained.
  • Use clean towels, razors, and other personal care items, and avoid sharing them with anyone else.
  • Wash your hands often.
WebMD Medical Reference Reviewed by Brunilda Nazario, MD on July 28, 2020

Sources

SOURCES:

Mayo Clinic: “Folliculitis.”

Medscape: “Hair Anatomy.”

DermNet New Zealand: “Folliculitis.”

Indiana University Bloomington Health Center: “Folliculitis.”

The International Foundation for Dermatology: “Management of Bacterial Infections of the Hair Follicles.”

Primary Care Dermatology Society: “Folliculitis and boils (furuncles/carbuncles).”

American Osteopathic College of Dermatology: “Folliculitis.”

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