This image shows a typical case of folliculitis.
This image shows a typical case of folliculitis.
The lesions of folliculitis may have a slight crust on top.
The lesions of folliculitis may have a slight crust on top.
This image displays a close-up of folliculitis with one of the lesions being pus-filled.
This image displays a close-up of folliculitis with one of the lesions being pus-filled.
The lesions of scalp folliculitis can be very itchy, resulting in scratching and scabs.
The lesions of scalp folliculitis can be very itchy, resulting in scratching and scabs.
This image displays very small pus-filled lesions centered on the hair follicles.
This image displays very small pus-filled lesions centered on the hair follicles.
After the initial small, red bump or pus-filled lesion, folliculitis lesions often form a small crust or scab.
After the initial small, red bump or pus-filled lesion, folliculitis lesions often form a small crust or scab.
Each of the red bumps seen in this image surrounds a tiny hair.
Each of the red bumps seen in this image surrounds a tiny hair.
Small pus-filled lesions form around hair follicles in folliculitis.
Small pus-filled lesions form around hair follicles in folliculitis.
This image shows lesions of folliculitis in different stages of healing. The red bumps are newer and active, while the brown spots are older.
This image shows lesions of folliculitis in different stages of healing. The red bumps are newer and active, while the brown spots are older.
Folliculitis with CA-MRSA (community-associated methicillin-resistant Staphylococcal aureus) confirmed by culture of the affected area.
Folliculitis with CA-MRSA (community-associated methicillin-resistant Staphylococcal aureus) confirmed by culture of the affected area.

Images of Folliculitis (10)

This image shows a typical case of folliculitis.
The lesions of folliculitis may have a slight crust on top.
This image displays a close-up of folliculitis with one of the lesions being pus-filled.
The lesions of scalp folliculitis can be very itchy, resulting in scratching and scabs.
This image displays very small pus-filled lesions centered on the hair follicles.
After the initial small, red bump or pus-filled lesion, folliculitis lesions often form a small crust or scab.
Each of the red bumps seen in this image surrounds a tiny hair.
Small pus-filled lesions form around hair follicles in folliculitis.
This image shows lesions of folliculitis in different stages of healing. The red bumps are newer and active, while the brown spots are older.
Folliculitis with CA-MRSA (community-associated methicillin-resistant Staphylococcal aureus) confirmed by culture of the affected area.

Folliculitis

Folliculitis is a skin condition caused by an inflammation of one or more hair follicles. It typically occurs in areas of irritation, such as sites of shaving, skin friction, or rubbing from clothes. In most cases of folliculitis, the inflamed follicles are infected with bacteria, especially with Staphylococcus (or “staph”) organisms, that normally live on the skin. Bacteria such as Pseudomonas may live in hot tubs, spas, and swimming pools and may also cause folliculitis.



Who's At Risk?

Folliculitis occurs in people of all ages, races / ethnicities, and sexes.

Further risk factors for folliculitis include:

  • Diabetes.
  • A suppressed immune system due to HIV, organ transplantation, or cancer.
  • An underlying skin condition, such as eczema, acne, or another inflammation of the skin (dermatitis).
  • Obesity.
  • Frequent shaving.
  • Pressure (eg, prolonged sitting on the buttocks).

Signs & Symptoms

The most common locations for folliculitis include the:

  • Scalp.
  • Buttocks.
  • Thighs.
  • Areas that are shaved, such as the beard area, underarms, groin, and legs.

Individual lesions of folliculitis include pustules (pus-filled bumps) and papules (small solid bumps) centered on hair follicles. These pustules and papules may be pierced by an ingrown hair, can vary in size from 2-5 mm, and are often surrounded by a ring of inflamed skin. In lighter skin colors, the lesions may be any shade of pink or red. In darker skin colors, the redness may be harder to see, and the bumps may be the only sign of the folliculitis. Occasionally, a folliculitis lesion can break open, drain, and then form a scab on the surface of the skin.

Mild and moderate cases of folliculitis are often tender and itchy. More severe cases of folliculitis, which may be deeper and may affect the entire hair follicle, can be painful.

Mild and moderate cases of folliculitis usually clear up quickly with treatment and leave no scars. More severe cases of folliculitis may lead to complications such as cellulitis (an infection of the deeper skin tissue), scarring, and permanent hair loss in the affected area.

Self-Care Guidelines

To prevent folliculitis:

  • Shave in the same direction of hair growth.
  • Avoid shaving irritated skin.
  • Use an electric razor or a new disposable razor each time you shave.
  • Avoid tight, constrictive clothing, especially during exercise.
  • Wash athletic wear after each use.
  • Consider other methods of hair removal, such as depilatories.

The following may help to clear up folliculitis if it is mild:

  • Use an antibacterial soap or wash (eg, PanOxyl Acne Creamy Wash, Hibiclens).
  • Launder towels, washcloths, and bed linens frequently, and do not share such personal items with others.
  • Wear loose-fitting clothing.

Treatments

Folliculitis is fairly easy to diagnose in most cases. Your medical professional may perform a bacterial culture to determine the cause of the folliculitis and may recommend:

  • Antibacterial wash, such as chlorhexidine (eg, Betasept, Hibiclens).
  • Topical antibiotic lotion or gel, such as erythromycin (eg, AkneMycin) or clindamycin (eg, Cleocin T).
  • Oral antibiotic pills, such as cephalexin (eg, Keflex) or doxycycline (eg, Vibramycin, Monodox), or ciprofloxacin (eg, Cipro) in the case of hot tub folliculitis.

Occasionally, the bacteria causing the infection are resistant to treatment with the usual antibiotics. This can sometimes cause a more severe form of folliculitis. Depending on the circumstances, your medical professional may consider more aggressive treatment that includes prescribing:

  • A combination of two different oral antibiotics, including trimethoprim-sulfamethoxazole (eg, Bactrim), clindamycin (eg, Cleocin), amoxicillin (eg, Amoxil), linezolid (eg, Zyvox), or tetracycline.

If your medical professional prescribes antibiotics, be sure to take the full course of treatment to avoid allowing the bacteria to develop resistance to the antibiotic prescribed.

Visit Urgency

Make an appointment to be evaluated by a dermatologist or another medical professional if the above self-care measures do not resolve the condition within 2-3 days, if symptoms come back frequently, or if the infection spreads.

Be sure to tell the medical professional about any recent exposure to hot tubs, spas, and swimming pools, as a less common form of folliculitis may be caused by contamination from these water sources.

If you are currently being treated for a skin infection that has not improved after 2-3 days of antibiotics, return to your medical professional.

References

Bolognia J, Schaffer JV, Cerroni L. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018.

James WD, Elston D, Treat JR, Rosenbach MA. Andrew’s Diseases of the Skin. 13th ed. Philadelphia, PA: Elsevier; 2019.

Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology. 9th ed. New York, NY: McGraw-Hill Education; 2019.

Last modified on June 14th, 2024 at 9:05 am

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