Folliculitis is a fairly common skin condition in which hair follicles become inflamed. Folliculitis is usually caused by a bacterial or fungal infection. Initially it appears as small red bumps or white-headed pimples around hair follicles. The infection can spread and cause nonhealing, crusty sores.
Folliculitis is not a life-threatening condition but it can become itchy and sore. Severe infections may lead to permanent hair loss and scarring. On the other hand, mild forms of the condition can clear in a few days with self-care treatments.
Certain types of folliculitis include hot tub rash, razor bumps and barber’s itch.
Symptoms of folliculitis include:
- Clusters of small red bumps or white-headed pimples around hair follicles
- Pus-filled blisters that break open and crust over
- Red and inflamed skin
- Itchy or burning skin
- Tenderness or pain
- A large swollen bump or mass
Types of superficial folliculitis
- Bacterial folliculitis: A common type characterized by itchy, white, pus-filled bumps. Bacterial folliculitis that develops in the beard area in men is known as barber’s itch. The hair follicles are usually infected with the bacteria Staphylococcus aureus (staph).
- Hot tub folliculitis (pseudomonas folliculitis): This form of folliculitis is caused by pseudomonas bacteria, which can be found in hot tubs, heated pools where chlorine and pH levels are not adequately regulated. The bacteria cause a rash of red, round and itchy bumps a few days after exposure. The bumps later develop into small pus-filled blisters (pustules).
- Barber’s itch (pseudofolliculitis barbae): Barber’s itch is an inflammation caused by ingrowing hairs. It mostly affects black men who shave and it is most noticeable on the face and neck. People who get bikini waxes may also develop barber’s itch in the groin area.
- Pityrosporum folliculitis: This form is more common in teens and adult men. It is caused by a yeast infection and causes chronic, red, itchy pustules on the back and chest or sometimes the neck, shoulders, upper arms and face.
Types of deep folliculitis
- Sycosis barbae: This form affects men who have recently begun to shave. Small pustules initially appear on the upper lip, chin and jaw. These can become more prevalent over days and weeks. Severe sycosis barbae can cause scarring.
- Gram-negative folliculitis: It sometimes appears as a result of a long-term antibiotic therapy for acne. An overgrowth of harmful bacteria in the nose called gram-negative bacteria can cause the bacteria to spread to the skin around the nose and mouth and lead to new, severe acne.
- Boils (furuncles) and carbuncles: These appear when hair follicles become deeply infected with staph bacteria. A boil occurs suddenly as a painful red bump causing the surrounding skin to also become red and swollen. The bump later fills with pus and grows before it ruptures and drains. Large boils may leave scars. A carbuncle is a cluster of boils.
- Eosinophilic folliculitis: This type of folliculitis mainly affects people with HIV/AIDS. Symptoms include intense itching and recurring patches of inflamed, pus-filled sores on the scalp, face, neck and upper chest. The sores cause hyperpigmentation (darkening of the skin) when they heal.
Folliculitis is caused by an infection of the hair follicles, most commonly from Staphylococcus aureus bacteria. It may also be caused by viruses, fungi and inflammation from ingrown hairs.
The condition can be identified as superficial or deep relative to how much of the hair follicle it involves. Deep folliculitis is more severe.
The most common causes of follicle damage are:
- Friction from shaving or tight clothing
- Heat and sweat, such as that caused by wearing rubber gloves or waders
- Certain skin conditions, such as dermatitis and acne
- Injuries to your skin, such as from scrapes or surgical wounds
- Coverings on your skin, such as plastic dressings or adhesive tape
Anyone can develop folliculitis; however, the following factors increase the risk of the condition:
- Other medical conditions (diabetes, chronic leukemia, HIV/AIDS)
- Acne or dermatitis
- Past damage to the skin (injury or surgery)
- Certain medications (steroid creams of long-term acne therapy)
- Being overweight
- Wearing clothing that traps heat and sweat (rubber gloves or high boots)
- Soaking in a hot tub that is not properly cleaned
Complications of folliculitis include:
- Recurrent or spreading infection
- Large, itchy patches of infected skin (plaques)
- Boils under the skin (furunculosis)
- Permanent skin damage (scarring or dark spots)
- Destruction of hair follicles and permanent hair loss