Folliculitis

Authored by Dr Laurence Knott, 06 Jul 2017

Patient is a certified member of
The Information Standard

Reviewed by:
Dr Helen Huins, 06 Jul 2017

Folliculitis means an inflammation or infection of the hair follicles of the skin. Most of the skin is covered with tiny hairs which grow out of hair follicles. In folliculitis, many hair follicles in one area of the skin are affected.

Folliculitis can be a mild, short-lived condition or a severe long-term problem that can literally take over your life. Unfortunately, this variation in severity can lead to the notion that it is nothing more than a passing inconvenience. This can be very frustrating if you have the more persistent form.

Folliculitis looks like lots of little pimples close together. The small, rounded yellow-red spots are actually infected hair follicles. So you won't find them on areas of the body where there are no hair, such as the palms of the hands (unless you're a werewolf!).

Some types occur more commonly than others. These include:

  • Sycosis barbae - this affects the beard and moustache area. It's obviously more common in men but some women with prominent facial hair can get it too. Some men who have this type grow beards to cover It up. So that man standing next to you on the tube with a flowing beard may not be a hipster, just a folliculitis camouflage expert!
  • Hot-tub folliculitis - the hot tub is a great place to socialise, not only for you but also for a nasty little bug called Pseudomonas aeruginosa. Pseudomonas will quite happily meet, date and multiply in your hot tub, eventually moving into your skin cells to raise a family. Fortunately, maintaining the chlorine level in the water and keeping the hot tub clean will encourage these unwanted squatters to move on.
  • Gram-negative folliculitis - for those who miss the joys of acne, there is always folliculitis. People with acne who have had antibiotic treatment to shift bugs (not staphylococci) may find they develop folliculitis, caused by their skin being invaded by Gram-negative germs (so called because they are not coloured by a technique called Gram staining in the laboratory).
  • Pseudo-folliculitis - this pretends to be folliculitis but is actually lumps caused by ingrowing hairs.

Read more about the symptoms of folliculitis.

Most cases are caused by a bug called Staphylococcus aureus (S. aureus). This infects hair follicles, especially where the follicle is damaged - for example, by friction or excessive sweating. Steroid cream users can also be prone to developing it. Arms, legs, buttocks and armpits are prime sites.

If the hair follicle and surrounding skin become infected, this is known as a furuncle. They can sometimes join together to form a carbuncle. Furuncles and carbuncles are commonly called boils. That old troublemaker, S. aureus, is usually involved. Acne can also look like folliculitis but the underlying cause is blockage of the follicles with oils from skin glands and dead skin cells.

Read more about the causes of folliculitis.

Things you can do yourself include shaving in the direction of hair growth and taking the occasional break from shaving. Anything you can do to avoid sweating, like wearing loose clothing, helps. Don't share towels, flannels or razors.

Mild cases often clear up in about week without any treatment. More persistent cases may need a moisturiser with an antibacterial agent and there are specific preparations which can be used as soap substitute for bath or shower.

If the folliculitis hasn't improved after a few days, see your GP. Antibiotic cream or tablets may be needed. If the condition persists or comes back after a successful course of treatment, you may require a nose swab for S. aureus. If you're a carrier, long-term antibiotic tablets, cream and an antiseptic skin wash or shower gel may be required. Laundering towels, bedding and clothing also helps.

Read more about the treatment of folliculitis.

Keep your skin clean and dry and try not to get it scratched or irritated. This is particularly important if you have an illness that makes you prone to infection, such as diabetes. Routine use of antiseptics can make the skin sore and dry but regular use of skin moisturisers may help. Don't share razors, and avoid communal use of hot tubs and Jacuzzis®. Wash clothes, towels and bedding on a hot wash.

Read more about the prevention of folliculitis.

Further reading and references

Hello, i have been getting boils in my groin area and thighs for about 4 years now. i have gone to my dr many many times. I have had blood tests to rule out diabeties. they have never taken a swap...

maria99745
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