Last updated: May 20, 2019
Richard Honaker M.D.
Primary Care Physician
View Full Profile
Everything you need to know about the skin ailment you never knew you probably have.
Many people dream of clear skin, yet they can’t seem to achieve it no matter how hard they try. If you are wishing for a clear complexion, but are dealing with itchy or painful red bumps you may not have acne. It could be a skin condition called folliculitis.
One of the reasons that many mistake folliculitis for acne is because they can be very similar in appearance. Both can produce red bumps that may or may not be filled with pus. Yet treatments for acne will not always work for folliculitis. In some cases, it can actually make the condition worse.
We asked our resident GP Dr. Honaker to lend us their insight on this common skin condition that often flies under the radar.
What is Folliculitis?
Folliculitis is characterized by the inflammation of hair follicles. The hair follicle is the small cavity of skin that holds each strand of hair. When these become damaged, they can become vulnerable to inflammation and infection. This inflammation can produce red or flesh-colored bumps that may swell as they become filled with pus or other biological waste.
Folliculitis can appear on many parts of the body. This is because most of your skin’s surface contains hair follicles. There are a few exceptions that include your eyelids, lips, soles of your feet and palms of your hands. Unfortunately, other than those few areas, your body is fair game.
Folliculitis Often Appears on the:
- Upper arms
- Genital area
What Causes Folliculitis?
Folliculitis is caused when damage to the hair follicle makes it vulnerable to infection and inflammation.
Damage to the hair follicle can occur from everyday activities such as:
- Wearing restrictive clothing
- Scratching or rubbing your head
- Wearing hair in tight hairstyles such as a ponytail or bun
- Habitually wearing hats or helmets
- Build up of hair product on the scalp from infrequent washings
- Irritation to the hair follicle from sweat or personal products
- Injuries to the skin such as cuts, scrapes or insect bites
- Improper Shaving methods
There are also some factors that can put you at a higher risk for folliculitis:
- If you are overweight or obese (increased likelihood of tight clothing and trapped sweat)
- You have a compromised immune system from HIV/AIDS, diabetes, or certain types of cancer
- Skin conditions such as acne or dermatitis
- Having coarse, curly hair
- You have an infected wound (infection could spread to nearby follicles)
- Frequently swimming or soaking in hot tubs, spas and pools that are not properly maintained
- Use of certain long-term medications, especially antibiotics and steroid creams
Types of Folliculitis
There are several different types of folliculitis. Most types are characterized by the type of organism that causes the inflammation or infection.
Bacterial Folliculitis is one of the most common types of folliculitis. It is caused by a bacteria that staphylococcus aureus, or staph. This type of germ is commonly found on the skin or in the nose of most healthy people. Once the bacteria is able to enter the skin, it is able to cause infection.
While most cases of bacterial folliculitis are minor, staph infections can become serious if left untreated and the infection is able to spread further into the body invading areas such as the bloodstream, lungs, bones or heart.
It is for this reason that it is so important to recognize the signs and symptoms of this type of folliculitis so you are able to seek proper treatment.
Pseudofolliculitis barbae is one of the most common types of folliculitis. This type is commonly called razor bumps or razor burn. This type of folliculitis is caused by ingrown hairs. Often occurring in those who have curly and coarse hair, ingrown hair is caused by hair strands that do not grow out of the skin and instead grow into the skin. The hair becomes trapped under the skin and the follicle becomes inflamed. Often this is characterized by red bumps around hair follicles.
This type of folliculitis can occur because of improper shaving methods. Often refraining from shaving for a period of seven to 10 days is required to allow this skin condition to heal.
Pityrosporum folliculitis is one type of folliculitis that can actually be made worse if treated with acne products. Many types of folliculitis are caused by bacteria, fungi or a virus penetrating a damaged hair follicle, but pityrosporum folliculitis is caused by an overgrowth of yeast.
Yeast and bacteria both occur naturally on the skin and are constantly balancing out each other. Many acne treatments can reduce the amount of bacteria on the skin and in turn, cause an overgrowth in yeast. This yeast can get into the hair follicle and rapidly multiply causing pityrosporum folliculitis.
This type of folliculitis also resembles acne and bumps may also become filled with pus. Many people seek medical intervention for this type of folliculitis because it can be extremely itchy.
Hot tub folliculitis is caused by soaking or swimming in hot tubs, spas, jacuzzis or heated pools that are not properly maintained. This type of folliculitis is also known as pseudomonas folliculitis. Pseudomonas aeruginosa is a type of bacteria that thrives in warm wet areas. It can survive in chlorinated water so it is important that both the chlorine and PH levels are maintained in any warm water that you soak or swim in.
Certain behaviors can make you more susceptible to hot tub folliculitis:
- Shaving, waxing or epilating your hair 24 hours before soaking or swimming
- Failing to shower after soaking or swimming
- Remaining in your swimsuit after swimming or soaking
This type of folliculitis can often strike where the water level hit your body or under your bathing suit area. The reason is that your swimsuit can trap the bacteria against your skin.
Scalp Folliculitis refers to the inflammation of the hair follicles on your scalp. This type of folliculitis can be especially challenging as many everyday self-care activities can cause damage to your hair follicles and leave your hair follicles vulnerable to infection.
These damaging activities include:
- Pulling your hair into tight hairstyles
- Scratching your head
- Wearing hats or helmets often
This type of folliculitis often begins on the hairline. While it may only occur on the hairline, it will often spread to include the scalp.
Signs and symptoms of scalp folliculitis include:
- Small red or flesh-colored bumps that may be filled with pus
- Itchy or painful bumps
- A tingling or sore sensation on your scalp
- Bumps that may drain pus
- Sores that may be brown or yellowish
It is important to seek treatment for this type of folliculitis as failure to do so can result in permanent hair loss in severe cases.
Learn more about the treatment options and the best prevention methods of scalp folliculitis
Herpetic folliculitis is caused by a virus rather than bacteria or fungus. The virus that causes this type of folliculitis is called herpes simplex, herpes zoster and molluscum contagiosum. This is usually seen in patients where they have a compromised immune system. Unlike Eosinophilic folliculitis, the immune system does not need to be compromised by major illnesses, and can be caused by as little as the flu.
In an article documented in the US Journal of Medicine National Institute of Health, a 30-year-old man who was otherwise considered healthy contacted folliculitis in the beard region after a flu-like illness. The patient had no prior history of herpes simplex, but his lesions tested positive for the virus.
Eosinophilic folliculitis is a rare form of folliculitis where the damage to the hair follicle is caused by internal factors rather than external. In other words, the hair follicle does not become damaged through everyday activities such as shaving or scratching but rather through internal changes in the body.
Eosinophils are a part of blood and some skin cells that helps to fight off foreign substances, such as an allergy. They travel to the problematic area of the body and release toxins. However, if too many toxins are released it can cause inflammation.
While the exact reason for this type of folliculitis is not known, a study published in the Indian Journal of Dermatology suggests that an increase in the number of Demodex mites (a ecto parasite found on human skin) can make the body more susceptible to bacteria entering the hair follicle. The study found evidence of increased Demodex mites in cases of eosinophilic folliculitis.
Eosinophilic folliculitis is also linked to immune deficiency. Often this type of folliculitis could be a sign of something more serious. Although it can also occur on patients with normal immune symptoms and even infants!
While there are several types of folliculitis, they fall into two main categories: superficial and deep.
Superficial folliculitis is an inflammation that only affects part of the hair follicle. This type of folliculitis is usually milder and may be able to resolve itself without medical intervention.
Bacterial folliculitis is caused by a bacteria called staphylococcus aureus. This bacteria lives on the skin and in the nose of healthy people.
Hot tub folliculitis (pseudomonas folliculitis) is caused by a bacteria that thrives in warm wet areas and can even survive in chlorinated water.
Razor bumps (pseudofolliculitis barbae) are caused by ingrown hairs. Men with coarse curly hair are often affected.
Pityrosporum folliculitis is caused by an overgrowth of yeast. This type of folliculitis can become worse with some traditional acne treatments.
Deep folliculitis refers to an infection or inflammation that affects the entire hair follicle. Often these cases require medical intervention. You may need to get antibiotics from a doctor or possibly have the area drained to encourage healing.
Boils (furuncles) and carbuncles: This deep infection and inflammation of the hair follicle are the result of a long-term staph infection. The infection will produce large, red and often painful bumps. When a cluster of boils forms together it is called a carbuncle.
Sycosis barbae: When razor bumps affect the entire hair follicle it is called sycosis barbae. These occur in the beard area and can cause large bumps that may be tender and can lead to scarring and may discharge pus.
Gram-negative folliculitis: Long term antibiotic treatment for acne can contribute to this type of folliculitis. The Gram-negative bacteria include: Serratia Escherichia coli, Pseudomonas aeruginosa, marcescens, Proteus and Klebsiella species.
Treatment of Folliculitis
Many mild cases of folliculitis can be easily treated without medical intervention in about a week. It is usually imperative to stop the behavior that caused the initial damage to your hair follicle in order to stop the cycle.
- If your folliculitis is caused by shaving you will need to refrain from shaving the area for about a week if possible.
- If you must shave, try not to go over the same area with your razor more than once.
- Change your razor between each use and do not share your razors
You can also encourage the healing of your folliculitis with some simple home remedies:
- Apply a warm compress to the area to help with pain or itch
- Apply a topical antibiotic cream such as neosporin or bacitracin
- Wash with a mild antibacterial soap
- Immediately shower after swimming, soaking and sweating
- Use shampoo with antifungal ingredients, such as tea tree oil
- Refrain from sharing towels, razors or face cloths
- Do not pick or ‘pop’ the bumps
Stop the Inflammation Before it Spreads
In some cases, your folliculitis cannot be treated with only these techniques. Ideally, folliculitis should be treated when it is superficial. This is to prevent the infection or inflammation from enveloping the entire hair follicle.
If you suspect you have folliculitis take note of the symptoms you are experiencing and then monitor your healing after starting home treatment. If your folliculitis fails to heal or spreads you may want to consult a doctor. Certain types of folliculitis need alternative treatments. For example, if your folliculitis is caused by an overgrowth of yeast rather than a bacterial or viral infection, it will require specialized treatment.
When to Speak to a Doctor:
- After a few days of treatment at home your folliculitis is not healing or is getting more severe or spreading
- The skin affected becomes warm, tender and red
- You have a fever above 100°F (38°C)
- You have flu-like symptoms or feel generally unwell
Is Folliculitis Contagious?
Folliculitis can spread, especially within your body. Many types of folliculitis are itchy which can lead the condition to spread.
Itching is one of the skin’s defense mechanisms. The brain sends the signal to itch the skin as a means to remove a potential external hazard. By scratching your folliculitis you can not only cause further damage to the hair follicles, but also new damage to the surrounding area.
Scratching folliculitis can also cause the sores to open and weep which can further spread the infection.
This is another reason that it is important to avoid shaving the area to allow the skin to heal. Shaving can also cause small cuts in the skin. If you have to shave, try not to go over the same area more than once and change your razor or razor blade each time you shave.
Not only can you spread folliculitis around your body, you can also potentially spread the infection to others.
For this reason it is extremely important to refrain from sharing personal items to stop the spread of folliculitis.
- Do not share towels
- Refrain from sharing razors
- No not share face cloths
For more information on stopping the spread of folliculitis check out Is Folliculitis Contagious?
Prevention of Folliculitis
Folliculitis is often easily treated at home. There are also some simple steps you can take to prevent this skin ailment. Determining the behavior that led to the follicle damage is often key in prevention of future outbreaks. Some behaviors cannot be completely stopped. Shaving is often a necessity, but you can always look to follow best practices to minimize damage.
Here are a few best practices to prevent folliculitis:
- Avoid wearing tight and restrictive clothing that can trap heat and sweat
- Lose weight
- Shower immediately after sweating or handling chemicals
- Wash with a mild antibacterial soap
- Use an anti-fungal shampoo
- Only use properly maintained hot tubs or pools
Is There a Cure for Folliculitis?
While there is currently no cure for folliculitis, some are able to find relief through alternative hair removal techniques. By choosing to use a depilatory cream to remove hair or even laser hair removal, some may find relief if their folliculitis was caused by shaving.
There is also the option to refrain from removing hair in order to avoid folliculitis. Many men can choose to grow out a beard in order to avoid the ingrown hairs associated with pseudofolliculitis barbae.
A Better Approach to Your Health
Taking a proactive approach to your health can mean the difference between clear skin from some simple home remedies or an infection that can lead to scarring or even permanent hair loss.
At Your Doctors Online, we believe in the power of accessible health care for everyone. You can access our doctors 24 hours a day, seven days a week for free. By simply downloading our free app you are able to have the power of connecting with a doctor with the touch of a button. Connect with one of our doctors today.
Disclaimer: This article provides general information and is not intended to diagnose, treat or cure any disease or medical condition. If you require specific advice, please consult one of our medical professionals through the app. However, in case of an emergency, please call 911.
About Richard Honaker M.D.
All Your Warm Weather Skin Questions Answered
Save your summer skin with our guide to playing it safe in the sand, surf ...Read more
Neglecting your scalp could lead to scalp folliculitis and permanent hair loss Many people ...Read more
Is Folliculitis a STD?
Got razor bumps? We look closer at whether the itchy red bumps in your bikini ...Read more