Last updated: May 20, 2019
Richard Honaker M.D.
Primary Care Physician
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Prevent folliculitis pain before it starts with our tips to spot, treat and prevent this common skin condition
You probably have Folliculitis and don’t even know it. While common, this skin condition still flies under the average person’s radar. Yet, if left untreated, extreme cases can turn painful, cause scarring and even permanent hair loss.
So what is this common skin ailment that is popular and yet unknown? We ask one of the Your Doctor’s Online resident GPs Dr. Honaker to give us some insight into this pesky skin problem.
What is Folliculitis?
Folliculitis refers to the small red or flesh colored bumps that can appear when the hair follicle becomes inflamed. This inflammation is often secondary to infection. This infection is able to penetrate the hair follicle when the follicle becomes damaged through the many activities we do each and every day such as:
- Shaving your body/head
- Rubbing/scratching our heads
- Wearing tight hairstyles such as ponytails or buns
- Regular wearing of helmets or hats
- Tight clothing-especially if it traps heat and sweat
- A build up of hair product on the scalp
- Skin clogging products
- Injuries to the skin that would allow bacteria in, such as a cut or insect bite
Unfortunately, folliculitis is not limited to the hair follicles on your head. The majority of the human body is covered in hair (with the exception of the soles of your feet, palms of your hands, lips and eyelids) so folliculitis can occur on almost any part of your body. It is most commonly found on the face, neck, chest, back, upper arms and groin area. Many mistake acne, which occurs were a pore becomes clogged with oil and dead skin, for folliculitis.
Signs and Symptoms of Folliculitis
Folliculitis starts off as a mild rash. It can produce red or flesh colored bumps that may or may not be filled with white or yellow pus. The area may feel itchy or tender to the touch. Over time these bumps may break and crust over. You may notice the area is swelling. In extreme cases, the infection may produce boils or carbuncles (clusters of boils) which are painful and may require lancing and draining by a doctor to speed up healing.
Types of Folliculitis
Folliculitis occurs when the hair follicle becomes inflamed after it becomes damaged. The cause of the inflammation varies and will determine the type of folliculitis you have.
Most commonly, the inflammation is caused by ingrown hairs, bacteria, fungi or a virus. In some extreme cases, it is cause by internal changes in the body. This is called eosinophilic folliculitis and can be a sign that your immune system is compromised.
While there are many different causes for the inflammation to appear, there are two main types of folliculitis: superficial and deep. Superficial folliculitis affects only part of the hair follicle and deep folliculitis affects the entire follicle.
Superficial folliculitis tends to resemble small bumps along the surface of the skin that are more likely to be itchy than painful. Deep folliculitis is more likely to appear under the surface in the form of a boil or cluster of boils which is red and painful to the touch.
Types of Superficial Folliculitis:
Bacterial folliculitis occurs when a break in the skin allows bacteria to enter the body and cause an inflammation. This common type of folliculitis is often caused by a staph infection. This type of folliculitis is characterized by small red and itchy pus filled bumps.
Hot tub folliculitis (pseudomonas folliculitis) is caused by soaking or swimming in a hot tub, whirlpool or heated pool that is not properly maintained. When the PH and chlorine levels of heated water are not properly maintained bacteria (called pseudomonas) can grown and cause this type of folliculitis. Small red bumps often appear under the area a bathing suit was worn (where bacteria was trapped) or where the water level hit the body about 48-72 hours after exposure.
Razor bumps (pseudofolliculitis barbae) is caused by ingrown hair and is a common cause of folliculitis. This type of folliculitis may also be called ‘barber’s itch’ or ‘razor burn’ and is often seen on the face and neck of men and in the legs, underarms and bikini area of women.
This type of folliculitis affects up to 60 percent of African American men and those with curly hair. While genetics play a factor in this type of folliculitis, improper shaving methods can also lead to this common skin condition.
Pityrosporum folliculitis is a type of folliculitis is particularly common with young adults and adult males. This type of folliculitis is caused by a yeast infection and causes chronic red, pus-filled bumps the back, chest, shoulders, upper arms and face.
Types of Deep folliculitis:
Boils (furuncles) and carbuncles can occur as the result of a long-term staph infection. This infection can produce large, red and painful bumps called boils. When many boils are produced in a cluster they are called carbuncles. Often boils will need to be lanced and drained by a doctor in order to encourage healing.
Sycosis barbae occurs when pseudofolliculitis barbae becomes a deep infection of the entire hair follicle. The infection will cause large and painful lumps that may be painful, discharge pus and resemble boils. This type of folliculitis can lead to scarring and permanent hair loss.
Gram-negative folliculitis is actually associated with long term antibiotic care for acne.The gram-negative bacteria include: Serratia Escherichia coli, Pseudomonas aeruginosa, marcescens, Proteus and Klebsiella species. In 80 percent of patients, gram-negative folliculitis caused superficial bumps filled with pus but in about 20 percent of cases the lesions are deeper and resemble large boils.
Eosinophilic folliculitis is a rare form of folliculitis which is caused by internal changes in your body rather than external damage. This type of folliculitis is often associated with a suppressed immune system and is often seen in those suffering from HIV/AIDS, diabetes and some types of cancer. The lesions produced by this type of folliculitis are persistent and can cause hyperpigmentation (darkening of the skin).
Treatment of Folliculitis
While many mild forms of folliculitis will clear up without any medical intervention, there are ways in which you can encourage their healing at home.
- Wash daily with a mild antibiotic soap
- Apply a cold compress to the affected area for pain and itch relief
- If possible, refrain from shaving the affected area for a week
- Do not attempt to scratch or ‘pop’ the bumps as it may spread the infection
- Apply an antibiotic cream to the area such as Bacitarin
- Use a shampoo with antifungal ingredients such as tea tree oil
Learn more about scalp folliculitis here
Signs you May Need to Speak to a Doctor
With any skin inflammation, it is important to regularly monitor the area. You want to make sure that the area is healing and the infection is not spreading. You may need to see a doctor if:
- The area becomes red and swollen
- The skin feels warm to the touch
- The bumps change to become filled with pus or the amount of pus changes
- You develop a fever
Prevention of Folliculitis
While many people may have experienced folliculitis at some point in their lives, the good news is there are lots of ways to prevent this skin ailment. Knowing the risk factors for these itchy and often painful bumps is the first step to achieving clearer skin in the future. Here are some best practices to keep your skin free from folliculitis.
- Only use hot tubs, spas and heated pools that are properly maintained. If you are unsure about the cleanliness of a water spot, just ask the attendant or home owner how often the PH and bacteria levels are checked. Twice a day is a good indication that it is safer to swim or soak
- After you swim or soak make sure to have a shower with soap right away. Do not sit around in a wet bathing suit which can trap bacteria.
- Make sure to wash your swimsuit between each use.
- Shower daily with a mild antibacterial soap. Make sure to shower immediately after any sweat inducing activities.
- Ensure that your clothes are loose and try to wear breathable fabrics
- Rinse out rubber gloves after each use
- Avoid shaving 24 hours before swimming or soaking. Make sure you are using proper shaving methods.
- Do not share towels, razors or other personal items.
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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.
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