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Folliculitis

Folliculitis

Folliculitis occurs when hair follicles become infected, often with Staphylococcus aureus or other types of bacteria. Certain variations of folliculitis are also known as hot tub folliculitis and barber's itch. Severe infections can cause permanent hair loss and scarring, and even mild folliculitis can be uncomfortable and embarrassing.

 

The infection usually appears as small, white-headed pimples around one or more hair follicles — the tiny pockets from which each hair grows. Most cases of folliculitis are superficial, and they may itch, but on occasion they're painful too. Superficial folliculitis often clears by itself in a few days, but deep or recurring folliculitis may need medical treatment.

Symptoms

Folliculitis signs and symptoms vary, depending on the type of infection.

 

Superficial folliculitis, which includes types that affect the upper part of the hair follicle, may cause:

  • Clusters of small red bumps that develop around hair follicles.
  • Pus-filled blisters that break open and crust over.
  • Red and inflamed skin.
  • Itchiness or tenderness.

 

Deep folliculitis starts deeper in the skin surrounding the hair follicle and affects the entire hair follicle. Signs and symptoms 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 is marked by itchy, white, pus-filled bumps that can occur anywhere on your body where hair follicles are present. When it affects a man's beard area, 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, scratching 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.
  • 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 when shaved hairs curve back into the skin. This leads to inflammation and, sometimes, to dark raised scars (keloid scars) on the face and neck.
  • Pityrosporum folliculitis. Especially common in teens and adult men, 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 if you're 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 and 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. The surrounding skin also may be red and swollen. The bump then fills with pus and grows larger and more painful before it finally ruptures and drains. 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, back or thighs. 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 those with HIV, 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.

 

When to see a doctor

 

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

Causes

Folliculitis is caused by an infection of the hair follicles by bacteria, viruses or fungi. The most common cause of folliculitis is Staphylococcus aureus bacteria.

 

Follicles are densest on your scalp, but they occur everywhere on your body except your palms, soles and mucous membranes, such as your lips. If follicles become damaged, they become susceptible to invasion.

 

The most common causes of 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.

Treatment

Mild cases of folliculitis will likely go away on their own. Persistent or recurring cases are likely to require treatment, however. The therapy your doctor recommends will depend on the type and severity of your infection.

 

  • Staphylococcal folliculitis. Your doctor may prescribe an antibiotic that you apply to your skin (topical) or that you take by mouth (oral). Your doctor may also recommend that you avoid shaving the affected area until the infection heals. If you must shave, use either an electric razor or clean razor blade every time.
  • Pseudomonas folliculitis (hot tub folliculitis). This condition rarely requires specific treatment, although your doctor may prescribe an oral or topical medication to help relieve itching (anti-pruritic). More-serious cases may require an oral antibiotic.
  • Tinea barbae. This infection — especially the inflammatory form — can be effectively treated with oral antifungal medications.
  • Pseudofolliculitis barbae. Self-care measures usually clear this condition. Shaving with an electric razor, which doesn't cut as closely as a razor blade does, can help. If you do use a blade, massage your beard area with a warm, moist washcloth or facial sponge to lift the hairs so that they can be cut more easily. Use a shaving gel instead of cream, and shave in the direction of the hair growth. When you're finished, rinse thoroughly with warm water and apply a moisturizing after-shave.
  • Pityrosporum folliculitis. Topical or oral antifungals are the most effective treatments for this type of folliculitis. Because the condition often returns once you've finished the course of oral medication, your doctor may recommend using topical ointments indefinitely. Antibiotics aren't helpful in treating pityrosporum folliculitis and may make the infection worse by upsetting the normal balance of bacteria on your skin.
  • Herpetic folliculitis. If you're a healthy adult, herpetic folliculitis may clear up without treatment. But if you're living with HIV/AIDS or you experience frequent cold sores, your doctor may prescribe an oral antiviral medication such as acyclovir (Zovirax), famciclovir (Famvir) or valacyclovir (Valtrex). Although these drugs can clear the infection, they won't necessarily prevent it from recurring.
  • Gram-negative folliculitis. Although this type of folliculitis results from long-term antibiotic therapy for acne, it's usually treated with certain antibiotics or with isotretinoin (Accutane).
  • Boils and carbuncles. Your doctor may drain a large boil or carbuncle by making a small incision. This relieves pain, speeds recovery and helps lessen scarring. Deep infections that can't be completely cleared may be covered with sterile gauze so that pus can continue to drain. Sometimes your doctor may prescribe antibiotics to help heal severe or recurrent infections.
  • Eosinophilic folliculitis. A number of therapies are effective, but topical corticosteroids are often the treatment of choice. Your doctor may prescribe a short course of oral corticosteroids if you have a severe infection. All steroids can have serious side effects and should be used for as brief a time as possible. If you're living with HIV/AIDS and have mild eosinophilic folliculitis, your doctor may prescribe topical steroids in conjunction with oral antihistamines. More-severe cases may require treatment with isotretinoin (Accutane) for several months.
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