Folliculitis Symptoms, Causes & Treatment Options

Folliculitis is an outbreak of inflamed red, sometimes pus-filled bumps in a hair-bearing area of skin. It is usually caused by bacteria and is commonly treated with topical antibiotics.

Folliculitis Symptom Checker

Take a quiz to find out if your symptoms point to folliculitis

Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Folliculitis?

Summary

Superficial folliculitis is an inflammation of one or many hair follicles that most commonly occurs on the scalp, beard area trunk, buttocks, and thighs. It looks like red bumps or white pus-filled bumps in a scattered distribution, and it may be itchy or painful. Folliculitis may occur after shaving (“razor bumps”) or after bathing in a hot tub (“hot tub folliculitis”). Usually, the cause is a bacterial infection of the hair follicles. Normal skin flora and Staphylococcus aureus (“staph”) are the most common bacteria. Fungi, viruses, and other agents may also be responsible for folliculitis. Most cases of folliculitis will resolve with topical antibiotic treatments applied to the skin, though some will require systemic antibiotic treatment. A doctor will be able to determine the cause of the folliculitis and prescribe an appropriate, tailored antimicrobial treatment. If untreated, folliculitis may progress to a more serious skin infection and may cause scarring or hair loss in some cases.

Recommended care

Folliculitis Symptoms

Main symptoms

Folliculitis is an inflammation of the hair follicle, usually caused by an infection. Many symptoms are possible. You may have the most common, superficial bacterial type of folliculitis if you notice any of the following:

  • Papules: “Papules” simply means bumps on the skin. In folliculitis, these bumps will be raised, red, and several millimeters to a centimeter in size.
  • Pustules: A “pustule” is a pus-filled papule, often with a white head (most commonly seen in acne).
  • Pain or itching: Papules and pustules may be painful or itchy.
  • Hair-bearing regions: Folliculitis is an inflammation of the hair follicle, so it occurs in hair-bearing regions, especially the scalp, beard, trunk, buttocks, and thighs.
  • Signs of hair follicle involvement: A key feature of folliculitis (versus other skin infections) is involvement of the hair follicle. One sign of hair follicle involvement is if a hair is visible inside of or protruding from the papule or pustule.
  • Hair follicle pattern: Another indication of hair follicle involvement is a pattern of papules or pustules that are spaced similarly to the surrounding hair follicles. This may look like evenly spaced red dots on a hair-bearing area.

Other types of folliculitis

Beyond superficial bacterial folliculitis, several other, rarer, types of superficial folliculitis are possible. Some of these are described below:

  • Hot tub folliculitis: This folliculitis will resemble the basic superficial folliculitis, but it is caused by a different type of bacteria (called Pseudomonas) that may live in hot tubs. This folliculitis may occur after using a hot tub or whirlpool.
  • Pseudofolliculitis barbae: This folliculitis will present with papules and pustules in the beard area after shaving, and favors males with darkly pigmented skin and tightly curled hair. Papules and pustules may progress to scarring [1].

Folliculitis Causes

Folliculitis is an inflammation of the hair follicle leading to formation of papules or pustules that may be painful or itchy. The most common cause of this inflammation is a bacterial infection of the hair follicle, though many other less common causes have been documented. Anyone can get folliculitis, though people with compromised immune systems may be at increased risk [2].

Bacterial causes of folliculitis

Superficial bacterial folliculitis can be associated with many different microbes. Some of the most common germs and descriptions of their associated folliculitis are listed below:

  • Normal skin flora: Most of the time, the bacteria causing the folliculitis can’t be isolated by a laboratory test called a bacterial culture – so this form is sometimes called “culture-negative folliculitis.” In this form, the normal bacteria living on the skin for some reason cause a folliculitis, which usually results in itchy papules and pustules.
  • Staphylococcus aureus: In cases where a bacteria can be isolated, Staphylococcus aureus (“staph”) is the most common agent. This folliculitis is likely to cause pustules or scaling of the skin.
  • Hot tub folliculitis: Hot tub folliculitis is caused by the Pseudomonas aeruginosa bacteria, that thrives in hot, wet environments. It causes a pink, itchy folliculitis that may require special treatment, and should prompt hot tub maintenance.

Other causes of folliculitis

Beyond the common bacterial causes of folliculitis, less common infectious agents like fungi, viruses, and mites may infect the hair follicle:

  • Fungal folliculitis: A variety of fungi, including the dermatophytes (that cause athlete’s foot) and Candida (more likely to affect those with weakened immune systems), may cause a folliculitis that can be especially itchy in some cases.
  • Viral folliculitis (herpetic folliculitis): The herpes virus, which is the cause of cold sores, is the most common cause of viral folliculitis. Herpetic folliculitis may look like pustules, or clear fluid containing vesicles on a red base. This infection is often seeded from shaving razors, especially in individuals with a history of recurrent herpes infections.
  • Mites (Demodex) folliculitis: Rarely, mites like the Demodex mite may be responsible for folliculitis, and these cases will require special treatment.
  • Other: Certain cases of folliculitis are not caused by infection at all – instead chemical irritants, friction from tight-fitting clothing, or the skin’s reactions to certain medications may be behind the inflammation.

Folliculitis Symptom Checker

Take a quiz to find out if your symptoms point to folliculitis

Treatment Options, Relief, and Prevention for Folliculitis

Treatment

Because there are so many potential causes of folliculitis, the first step toward effective treatment is an accurate diagnosis. A dermatologist may determine the cause of folliculitis by swabbing a pustule or papule and sending away for laboratory diagnosis. Treatments for the various causes of folliculitis are listed below [3]:

  • Any folliculitis: A good first step for any folliculitis is to keep the area clean and dry for several days. It is possible that the infection will clear at this time and no further treatment will be necessary.
  • Culture-negative folliculitis: Initial treatments may include topical antimicrobials like benzoyl peroxide clindamycin. If topical treatments are unsuccessful, certain oral antibiotics like doxycycline, or tetracycline may be effective at disrupting bacteria and soothing inflammation.
  • Staphylococcal folliculitis: A topical antibiotic called mupirocin is the treatment of choice if staph bacteria is isolated from folliculitis. Resistant or recurrent cases may require oral antibiotics tailored to the specific bacterial strain.
  • Hot tub folliculitis: Often this infection will resolve on its own. In severe cases, oral antibiotics targeting Pseudomonas aeruginosa may be necessary. An outbreak of hot tub folliculitis should also prompt cleaning of the hot tub or whirlpool.
  • Fungal folliculitis: Fungal folliculitis will require a specific antimicrobial treatment with topical or oral medications targeted to the specific fungus. Dermatophyte infections will likely require oral medications (for example, griseofulvin or terbinafine), while candida infections will need treatment with fluconazole or related agents. Viral herpetic folliculitis: Oral antiviral medications are the best treatment for severe herpes virus outbreaks. Examples include valacyclovir (Valtrex) and acyclovir.
  • Irritant/drug folliculitis: If irritant folliculitis is suspected, the only effective treatment is to stop the offending agent – this may mean suspending wear of tight clothing on the area or discontinuing a cosmetic applied to the area. If a medication is the suspected cause, speak with your doctor about discontinuing that medication, or swapping it for another.

Prevention

The majority of folliculitis is caused by bacteria – many of the techniques below describe ways to reduce the presence of harmful bacteria on the skin to prevent folliculitis [4].

  • Good shaving practice: Folliculitis often occurs after shaving. Practice good shaving hygiene by NEVER sharing razors with others. Use the newest, sharpest razor possible, apply shaving cream and aftershave, and shave with the grain of the hairs to minimize the change of follicular infection or irritation.
  • Hand washing: Hand hygiene – washing hands after touching the folliculitis, and using hand sanitizer regularly - will prevent the spread of existing folliculitis and the development of new infections.
  • Antibacterial soap: Washing daily or even several times per week with an antiseptic soap like chlorhexidine wash (Hibiclens) can reduce staph and other bacteria on the skin.
  • Bleach baths: Bathing in dilute bleach as directed by a physician can help to reduce bacterial populations on the skin.
  • Prevent nasal carriage and transmission: Reduce staph populations carried in the nose by applying antibiotic ointment to the inside of the nostrils. Prevent transmission from the nose by not picking the nose.
  • Prevent anal carriage and transmission: Staph may also live in the gluteal cleft and anus, especially in small children. These areas can also be decolonized using antibiotic ointments, antibacterial soap, and by always wearing clean underpants.
  • Family decolonization: Other family members, even those who don’t get boils, can remain colonized and spread bacteria. Consider decolonizing the whole family at once, and don’t share towels, razors, or other personal items that may carry bacteria.

When to Seek Further Consultation for Folliculitis

If left untreated, superficial folliculitis can progress to deep folliculitis (commonly called boils, furuncles, or carbuncles), or cellulitis (a more severe infection of the deep skin tissue).

Untreated or severe folliculitis may also cause scarring, changes in skin color, and destruction of hair follicles leading to hair loss that may be long-lasting or even permanent [2].

You should see a dermatologist is folliculitis does not resolve within days to weeks, spreads rapidly, recurs frequently, or if it is bothersome or worrisome to you in any way. A doctor like a dermatologist will be able to definitively diagnose folliculitis and can prescribe a treatment tailored to your individual case.