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Folliculitis - Inflammation of Hair Follicles

By Liji Thomas, MD

Hair follicles are tiny sacs with hair-generating cells at the bottom. Folliculitis is an inflammation of one or more hair follicles. It is most often seen in the beard area (called ‘barber’s itch’), the arms, back, buttocks and legs. This is usually due to bacterial infection with Staph. However, viruses such as herpes zoster, and fungi, such as Microsporum, or yeast organisms like Malassezia, may also cause folliculitis.

Folliculitis is also common when the skin pores are blocked, allowing sebum to pile up. Another predisposing factor is skin irritation or the presence of another skin disease. A non-infective type of folliculitis occurs because of regrowth of hairs after hair removal, by plucking, electrolysis or shaving.

This more commonly affects people with curly hair.

Folliculitis is more common with:

  • The use of a dull razor blade
  • The use of scratchy or prickly fabrics
  • The use of tight clothes
  • Excessive sweating
  • The use of heavy makeup
  • Contact with machine oils
  • The presence of infection on neighboring skin
  • The use of very hot showers or tubs
  • The presence of immunosuppression, as in HIV or diabetes

All these cause follicular irritation, making them prone to inflammation. Spa folliculitis is caused by a different organism called Pseudomonas, which grows in swimming pools, if there is too little chlorine in the water. This variety occasionally occurs on the face, usually following treatment with tetracyclines for acne.

Symptoms

The main symptoms of folliculitis are the appearance of small swellings on the skin, which look rather like pimples. Each swelling is centered on a hair. These are red and painful, often crusted or pustular, and may be itchy or burning. They may eventually burst open, releasing a little pus, or some bloodstained fluid, and finally subside. ‘Hot tub’ folliculitis presents as several little reddish swellings, on the stomach, arms or legs. Some people also feel feverish or have stomach upsets.

Diagnosis and treatment

Folliculitis is diagnosed by the location of the swellings around the skin hairs, and by the presence of risk factors in your history. Staph folliculitis is very frequent, and it is treated with local antibiotic creams and skin cleansers. Sometimes it may mimic other skin conditions like a heat rash, but tests will reveal the true diagnosis. Swabs are taken from the pustule or papule to detect infective organisms.

Folliculitis needs only symptomatic treatment in most cases, since the inflammation often clears up in a week or 10 days without any specific treatment. The application of warm compresses to the affected area gives relief from the burning or itching. The addition of some salt or Burow’s solution to the warm water may help. Antifungal or antiseptic shampoos will help treat folliculitis of the scalp or face. Avoid shaving or hair removal from the irritated area till the folliculitis subsides.  

Indications for antibiotic treatment in folliculitis include:

  • Persistence of folliculitis after two or three days
  • Worsening of the condition with symptomatic treatment
  • Frequent recurrence of the condition
  • Appearance of infective symptoms such as spreading redness, warmth and pain, especially with fever

However, if folliculitis is due to a fungal infection, antibiotics and moisturizers must be avoided, and antifungal agents are required.

Chronic folliculitis is often due to persistent bacterial colonization of the skin of some part of the body, such as the nose. This requires both systemic and topical antibiotics for a period sufficient to eradicate the organism causing the folliculitis. In addition, antiseptic body washes and sanitization of all bedclothes and clothes will help.

Keeping the bathtub clean, laundering washcloths and towels properly after each wash, using separate washcloths and towels for each person, and avoiding oily makeup, are other essential steps in the prevention of folliculitis.

References

Last Updated: Apr 19, 2015

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