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About folliculitis

What is folliculitis?

Folliculitis facts

  • Folliculitis is a very common, benign skin disorder that appears as pinpoint red bumps sometimes with a small dot of pus at the top.
  • Folliculitis affects people of all ages, from babies to seniors.
  • The numerous smooth little red bumps form around hair follicles and are most common on the face, scalp, chest, back, buttocks, and legs.
  • Folliculitis is often seen in otherwise healthy people, it's easily curable in most cases, and frequently clears on its own without treatment, though it may require ongoing maintenance therapy.
  • Antibacterial over-the-counter medications containing benzoyl peroxide are often used to treat folliculitis, but resistant cases may need antibiotic pills to clear the skin.
  • Good skin hygiene and proper shaving techniques have been shown to prevent folliculitis.

What is folliculitis? What are folliculitis symptoms and signs? What does folliculitis look like?

Folliculitis is an inflammatory condition affecting hair follicles. It appears as a small red tender bump occasionally surmounted with dot of pus surrounding a hair. Older lesions that have lost the pus appear as red bumps surrounding the opening of the follicle. One to hundreds of follicles can be affected anywhere that hair is present. Actually, acne vulgaris, the facial rash that teenagers develop, is a type of folliculitis.

Depending on the cause and severity of folliculitis, it may require no treatment and resolve spontaneously, or it may require treatment with powerful antibiotics or other drugs.

What are common types of folliculitis?

Steroid folliculitis

Systemically administered or topically applied steroids (cortisone medications) are a well-known cause of folliculitis.

Cutting oil folliculitis

Machinists exposed to insoluble cutting oils that are used to decrease the friction between machine tools and metal parts can develop a folliculitis on the exposed skin.

Staphylococcal folliculitis

Staphylococci are bacteria that commonly inhabit the skin. One species, S. aureus, is a frequent cause of folliculitis. Occasionally, this organism may be insensitive to a number of commonly used antibiotics (such as methicillin-resistant Staphylococcus aureus, or MRSA). In this situation, it is very important that a culture of the organism with sensitivities be performed so the ideal antibiotic is selected.

What is hot tub folliculitis or Jacuzzi folliculitis?

Hot tub folliculitis is caused by the bacteria Pseudomonas aeruginosa. This condition is likely to occur from bathing in poorly maintained hot tubs. It is most common on the back and causes scattered pinpoint, small red to purple bumps all over the torso. These may be very itchy or have no symptoms at all. Typically, there is a history of sitting in a hot tub days prior to the start of the bumps. It is good practice to rinse off the skin in a shower after this sort of bathing.

The hot tub should be tested and possibly treated by trained pool and spa personnel for bacterial overgrowth. Affected patients may be more prone to recurrences in the future and should be cautious about hot tub use. Although this condition often resolves without treatment, it may be useful to rinse the skin with dilute vinegar.

What is razor burn folliculitis?

Razor-burn folliculitis is very common on the male neck and women's legs and is caused by shaving. Repeated passes by the razor produces tiny cuts that allow bacteria to enter the skin and invade the deeper hair follicles. Additionally, excessively close shaving may cause trapping of small hairs beneath the skin surface, causing more inflammation.

Treatment involves stopping shaving with a razor for a few days to a few weeks and using antibacterial washes and topical antibiotics. Additional treatments include laser hair removal, electrolysis, electric razors, or cream depilatories like Neet or Nair. Frequently, shaving less vigorously and leaving a small bit of stubble is advisable.

What is pseudofolliculitis barbae?

Pseudofolliculitis barbae is a very common ingrown hair condition on the beard area (lower face and neck) of men. Typically, there are groups of small red bumps on the beard area that may flare with repeat shaving. Pseudofolliculitis tends to be worse with very curly or kinky hair. It can be quite debilitating especially if one's employment requires a closely shaven appearance. Cutting the hair close to or below the follicular orifice results in hairs that penetrate into the follicular wall as they twist and grow. These trapped hairs cause irritation and inflammation at the hair follicles.

Treatment goals include avoiding overly aggressive shaving, trial of the "bumps-free razor," and antibacterial benzoyl peroxide shaving gels. Other treatment options include professional laser hair removal, electrolysis, electric razors, or a prescription drug called eflornithine (Vaniqa).

What are possible complications of folliculitis?

Complications are infrequent since folliculitis is usually a self-limited skin condition. Rarely, the infected bumps may enlarge, causing an abscess (furuncles or carbuncles) or painful cysts requiring minor surgical drainage. Deeper or more extensive skin infections called cellulitis can be a rare complication.

Another potential complication includes temporary skin discoloration called post-inflammatory hypopigmentation (lighter than the regular skin color) or hyperpigmentation (darker then the regular skin color). This altered skin color may occur after the inflamed red bumps have improved or after a temporary flare.

Permanent scarring is uncommon but may occur from picking, overly aggressive scrubbing, or other deep inflammation.

What are the symptoms for folliculitis?

Tender skin symptom was found in the folliculitis condition

Folliculitis signs and symptoms include:

  • Clusters of small red Bumps or white-headed Pimples that develop around hair follicles
  • Pus-filled Blisters that break open and crust over
  • Itchy, Burning skin
  • Painful, tender skin
  • A large swollen bump or mass

When to see a doctor

Make an appointment with your doctor if your condition is widespread or the signs and symptoms don't go away after a few days. You may need an antibiotic or an antifungal medication to help control the condition.

Types of folliculitis

The two main types of folliculitis are superficial and deep. The superficial type involves part of the follicle, and the deep type involves the entire follicle and is usually more severe.

Forms of superficial folliculitis include:

  • Bacterial folliculitis. This common type is marked by itchy, white, pus-filled bumps. It occurs when hair follicles become infected with bacteria, usually Staphylococcus aureus (staph). Staph bacteria live on the skin all the time. But they generally cause problems only when they enter your body through a cut or other wound.
  • Hot tub folliculitis (pseudomonas folliculitis). With this type you may develop a Rash of red, round, itchy Bumps one to two days after exposure to the bacteria that causes it. Hot tub folliculitis is caused by pseudomonas bacteria, which is found in many places, including hot tubs and heated pools in which the chlorine and pH levels aren't well-regulated.
  • Razor Bumps (pseudofolliculitis barbae). This is a skin Irritation caused by ingrown hairs. It mainly affects men with curly hair who shave too close and is most noticeable on the face and neck. People who get bikini waxes may develop barber's itch in the groin area. This condition may leave dark raised scars (keloids).
  • Pityrosporum (pit-ih-ROS-puh-rum) folliculitis. This type produces chronic, red, Itchy pustules on the back and chest and sometimes on the neck, shoulders, upper arms and face. This type is caused by a yeast infection.

Forms of deep folliculitis include:

  • Sycosis barbae. This type affects males who have begun to shave.
  • Gram-negative folliculitis. This type sometimes develops if you're receiving long-term antibiotic therapy for acne.
  • Boils (furuncles) 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. A carbuncle is a cluster of boils.
  • Eosinophilic (e-o-sin-o-FILL-ik) folliculitis. This type mainly affects people with HIV/AIDS. Signs and symptoms include intense Itching and recurring patches of Bumps and Pimples that form near hair follicles of the face and upper body. Once healed, the affected skin may be darker than your skin was previously (hyperpigmented). The cause of eosinophilic folliculitis isn't known.

What are the causes for folliculitis?

Folliculitis is most often caused by an infection of hair follicles with Staphylococcus aureus (staph) bacteria. Folliculitis may also be caused by viruses, fungi and even an inflammation from ingrown hairs.

Follicles are densest on your scalp, and they occur everywhere on your body except your palms, soles, lips and mucous membranes.

What are the treatments for folliculitis?

Most cases of folliculitis are completely curable. There are very uncommon, long-standing cases of folliculitis that may not be curable. Often these more resistant cases may be controlled with proper treatment and medication. Folliculitis sometimes clears completely by itself without treatment. It usually improves after the teen years and young adulthood. Most patients may expect a short course with easy clearing.

Although most folliculitis is not contagious, folliculitis caused by an infectious agents may be transmitted through person-to-person skin contact, shared razors, or through Jacuzzis or hot tubs. It is possible to give it to someone else through close skin contact. Some people are simply more prone to developing folliculitis because of their overall health, possible altered immune status, exposure history, and other predisposing skin conditions like eczema or severely dry skin.

What is the treatment for folliculitis? Are there any home remedies for folliculitis?

There are many treatment options and skin-care recipes for treating folliculitis. The specific treatment depends on the cause of the folliculitis.

Home therapy for mild cases of bacterial folliculitis includes use of an over-the-counter antibacterial wash like benzoyl peroxide (Clearisil, Proactiv), chlorhexidine (Hibiclens), or Phisoderm twice a day. The best results may be achieved with combination therapy using topical products and antibacterial washes.

Holistic treatment for folliculitis may include soaking the affected area in a tub of diluted white vinegar (1 part vinegar to 4 parts of water) or soaking in a bathtub with very diluted Clorox bleach (¼ cup of Clorox bleach in a bathtub full of water).

Bacterial folliculitis may be treated with antibacterial skin washes and topical and/or oral antibiotics. It is important to keep in mind that as with any condition, no therapy is uniformly effective in all people. A doctor may need to help evaluate the cause of the folliculitis.

Moderate cases of bacterial folliculitis may be treated by a routine of twice-daily application of a topical antibiotic, such as clindamycin lotion or metronidazole lotion. A five- to 30-day course of an oral antibiotic like cephalexin (Keflex), dicloxacillin (Dynapen), doxycycline, minocycline (Dynacin, Minocin), ciprofloxacin (Cipro), or levofloxacin (Levaquin) may be used for folliculitis that is more resistant. After initial clearing with stronger medications, a milder maintenance antibacterial wash and topical antibiotic may be recommended.

Fungal or yeast folliculitis is often treated with an antifungal shampoo or body wash such as ketoconazole (Nizoral shampoo) twice daily. More resistant or deeper fungal folliculitis may require the addition of a topical antifungal cream such as miconazole (Lotrimin) or terbinafine (Lamisil) and an antifungal pill such as fluconazole (Diflucan).

Persistent skin discoloration called hyperpigmentation may be treated with prescription fading creams like hydroquinone 4%, kojic acid, and azelaic acid 15%-20%. Over-the-counter fading creams with 2% hydroquinone like Porcelana may be somewhat effective.

What are the risk factors for folliculitis?

Anyone can develop folliculitis. But certain factors make you more susceptible to the condition, including:

  • Having a medical condition that reduces your resistance to infection, such as diabetes, chronic leukemia and HIV/AIDS
  • Having acne or dermatitis
  • Taking some medications, such as steroid creams or long-term antibiotic therapy for acne
  • Being a male with curly hair who shaves
  • Regularly wearing clothing that traps heat and sweat, such as rubber gloves or high boots
  • Soaking in a hot tub that's not maintained well
  • Causing damage to hair follicles by shaving, waxing or wearing tight clothing

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