Folliculitis

Folliculitis is most often caused by chronic irritation to hair follicles. Daily shaving, chronic rubbing by clothing or workout equipment, and physical manipulation are common causes of inflammatory folliculitis. The bacteria staphylococcus aureus can enter the hair follicles, creating a staph infection.

The infected follicles will appear as red, pus-filled bumps with mild to moderate discomfort and/or itching. A common vacation condition is referred to as “hot tub folliculitis.”  This is caused by the bacteria pseudomonas aeruginosa, which grows in the warm hot tub water. There have also been outbreaks in water parks.

Since we have hair covering most of our body, this disorder can develop on any area—with the exception of the palms of our hands and soles of our feet. It occurs most often on the face, upper back, arms, neck, thighs, lower legs, buttocks, and armpits. Patients who have folliculitis may experience irritation, itching, and pain. If the condition is mild, patients may not even know they have it until they see it.

There are two main categories of folliculitis: superficial, which occurs when the follicle is only partially damaged, and deep, when the entire follicle is damaged.

The superficial type is more common than the deep type. Most people who shave experience this at some point in their lives. Deep folliculitis may develop into painful boils (furuncles and carbuncles). Incision and drainage of the involved area by a dermatologist may be necessary when this occurs.

Chronic irritation to the hair follicles is the biggest risk factor for folliculitis.  Recommendations to avoid the condition include wearing loose-fitting clothing, showering right after working out, using “bump fighter” razors and shaving cream, avoiding long-term use of topical steroids, staying out of public hot tubs and water parks, and not cutting curly hair too close to the skin. Cutting curly hair too close to the skin leaves the skin predisposed to ingrown hairs, which create inflammation. This condition is referred to as pseudofolliculitis barbae.

Chronic irritation to the hair follicles is the biggest risk factor for folliculitis.  Recommendations to avoid the condition include wearing loose-fitting clothing, showering right after working out, using “bump fighter” razors and shaving cream, avoiding long-term use of topical steroids, staying out of public hot tubs and water parks, and not cutting curly hair too close to the skin. Cutting curly hair too close to the skin leaves the skin predisposed to ingrown hairs, which create inflammation. This condition is referred to as pseudofolliculitis barbae

Diagnosis is most often made by clinical presentation. If bacterial infection is suspected, a bacterial culture will be performed. Treatment options include avoiding chronic irritation to the follicles, as noted previously. Topical and oral antibiotics and a topical steroid may be prescribed. Incision and drainage may be necessary for more severe cases. Compresses with diluted white vinegar (one part white vinegar to four parts of water) and witch hazel application can be done at home to help heal the involved areas.

Many rashes share common symptoms: redness, itching, discomfort, and pain. Our dermatologists can diagnose the problem, from poison ivy to hives, so the most appropriate treatment can be applied to bring relief.