Alternative Names: Pseudofolliculitis barbae; Tinea barbae; Barber's itch.
Folliculitis is probably the most common of all skin infections. Although usually trivial, it can produce extensive disease. It may be superficial or deep, and it causes the formation of a pustule or inflammatory nodule surrounding the hair. The infected hairs may be easily removed.
A more extensive folliculitis of the sebaceous gland (the oily secreting glands) with some involvement of subcutaneous tissues is termed a furuncle (or boil).
An acute eruption or one present for only a short time is usually due to Staph bacteria (impetigo of Bockhart). This is treated with oral cephalexin, dicloxacillin or similar oral antibiotic. Topical antibiotics creams or lotions can also be used. Bactroban ointment should be applied into the front of the nose for several days to prevent a carrier state. While this may seem like it makes no sense, the inside front area of the nostrils is often a place where bacteria can survive a course of oral antibiotics. Later, they spread back to the skin to cause a relapse.
Chronic or recurring folliculitis is less likely to clear with just antibiotics. Often this is on the legs of women, but it can occur in any areas of shaving, waxing, hair plucking or friction. These need to be stopped for at least 3 months to allow the hair to grow in healthy. If shaving is resumed, one should shave with the grain of the hair; it won't feel quite as smooth, but it will look a whole lot better.
Superficial Folliculitis Types: Superficial folliculitis is common, but because it is often self-limited, patients rarely present to the doctor. Those who are seen more often have either recurrent/persistent superficial folliculitis or have deep folliculitis. Although the incidence is unknown, certain conditions make patients more susceptible. These include frequent shaving, immunosuppression, preexisting dermatoses, long-term antibiotic use, occlusive clothing and/or occlusive dressings, exposure to hot humid temperatures, diabetes mellitus, obesity, and use of EGF-R inhibitor medications.
Staphylococcal folliculitis: This common type of folliculitis is marked by itchy, white, pus-filled bumps that can occur anywhere on your body. When it affects the beard area of men, 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 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. You're at increased risk of infection if you have diabetes, a history of skin infections, or open cuts or sores.
- 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
- Pityrosporum folliculitis: Especially common in young and middle-aged adults, 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:
Gram-negative folliculitis: This sometimes develops in people 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 to the cheeks, chin and jaw line, where they 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 about 1/2 inch in diameter. The surrounding skin also may be red and swollen. Within 24 hours, the bump fills with pus. It grows larger and more painful for five to seven days, sometimes reaching golf ball size before it develops a yellow-white tip that finally ruptures and drains. Boils generally clear completely in about two weeks. 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 or thighs, especially in older men. 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 HIV-positive people, 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.
The symptoms may be pain, erythema (inflammation and redness of the skin) and edema
. The lesions may range from tiny white-topped pustules to large, yellow pus-filled lesions.
If it progresses, the complaints may be of hard, painful nodules
. If the nodules enlarge and rupture, there may be pus on the skin surface.
In severe cases, it may progress to a systemic infection where there would be fever and malaise
Causes and Risk factors:
Every hair on your body grows from a follicle, a small pocket of modified skin. Although follicles are densest on your scalp, they occur everywhere except your palms, soles and mucous membranes, such as your lips.
Each follicle is attached to a small muscle. When you're cold or frightened, the muscle contracts, raising the hairs above the level of your skin and giving the appearance of goose bumps. Just above these muscles are sebaceous glands that produce an oil (sebum) that lubricates your skin and coats each hair shaft. Sebum is carried to the follicles and skin in tiny ducts.
Normally, the follicles carry out these functions with few problems. But when they're damaged, they may be invaded by viruses, bacteria or fungi, leading to infections such as folliculitis.
The most common cause of folliculitis is infection by the bacteria Staphylococcus aureus. Other species of bacteria may also be responsible. For example, contaminated water in whirlpools and hot tubs can transmit Pseudomonas aeruginosa, which can cause folliculitis. This bacterium may also be passed in wet suits.
Fungal and viral infections can also cause the condition. These are not common, but doctors may suspect these agents if conventional treatments do not work. Viral infections may be more common in those with compromised immune systems, such as AIDS, organ transplant, and cancer patients.
The most common causes of hair 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.
- Exposure to coal tar, pitch or creosote — common among roofers, mechanics and oil workers.
Anyone can develop folliculitis, but certain factors make you more susceptible to the condition. These include:
Medical conditions that reduce your resistance to infection, such as diabetes, chronic leukemia, organ transplantation and HIV/AIDS.
- A pre-existing skin condition, such as acne or dermatitis.
- Trauma to your skin from surgery.
- Long-term antibiotic therapy for acne.
- Topical corticosteroid therapy.
- Obesity — folliculitis is more common in people who are overweight.
- Living in a warm, humid climate.
If your doctor thinks that you have folliculitis, he or she will examine the skin over your entire body, especially on your arms, legs, buttocks, and scalp. If you are a man, your doctor will also examine the skin of your beard. In general, a doctor will suspect folliculitis if he or she finds hairs in the center of pus-filled pimples (pustules).
If folliculitis is diagnosed and it is severe, your doctor may do testing to find out what is causing the infection. Most cases of folliculitis are caused by bacteria, most commonly by a type called Staphylococcus aureus. It can also be caused by a fungus, such as Candida albicans.
If your doctor suspects bacteria is causing your infection, he or she may take a sample of the fluid from inside a pustule to identify the type of bacteria. The fluid is sometimes analyzed right at the doctor's office, in which case the results are available immediately.
To diagnose a fungus, the doctor will take a tissue sample, or biopsy, of the infected area. If fluid or biopsy samples are sent to an outside lab, you will get the results in a few days.
Folliculitis usually clears up quickly and it may get better on its own. However, depending on how severe it is, your GP may recommend some medicines to help clear up the infection.
Antiseptics: Mild folliculitis can often be treated by washing the affected area every day with an antiseptic product. Your GP will prescribe you a suitable product. These will usually contain an antiseptic such as chlorhexidine (eg Hibiscrub) or triclosan (eg Aquasep). These can come as lotions, creams, soap substitutes or bath additives.
Antibiotic creams: Your GP may prescribe you a cream or ointment containing fusidic acid (eg Fucidin) if the folliculitis affects just a small area. This is a type of antibiotic that kills the bacteria infecting your hair follicles. He or she may use other antibiotic creams or ointments, such as mupirocin (eg Bacticab).
Antibiotic tablets: If the folliculitis is severe, or keeps coming back, your GP may prescribe you antibiotic tablets. Some examples include flucloxacillin and erythromycin, but he or she may recommend other types.
Some folliculitis infections can be so persistent that antibiotics stop working. Your doctor may recommend a laser treatment, which obliterates hair follicles to stop hair growth and scarring. UV-B phototherapy is an option if you suffer from eosinophilic pustular folliculitis, but this treatment can actually cause folliculitis if the technician puts coal tar on you before you enter the light box. If you have recurrent staphylococcus folliculitis, your doctor may recommend applying a mupirocin ointment in your nose regularly. Staph bacteria are present on everyone's skin, but the ointment can reduce the population and heal your wounds.
Medicine and medications:
You can use antibiotics to cure a bacterial folliculitis infection. Less-severe cases can be treated with a topical ointment such as bacitracin. Or your doctor may prescribe an antiseptic cleanser, such as povidoneiodine or chlorhexidine. For more severe infections, your doctor will prescribe an antibiotic pill, such as cephalexin, ofloxacin or dicloxacillin. Some infections, pseudomonas folliculitis among them, may not require any antibiotic pills unless the infection worsens.
Most fungal folliculitis infections, such as pityrosporum folliculitis, are treated with prescription medications. Your doctor probably will prescribe fluconazole or terbinafine. You can reduce inflammation of a fungal infection with ice packs or with a prescription corticosteroid.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.