Folliculitis – Symptoms and Causes

What Is Folliculitis?

Folliculitis is a skin problem where hair follicles become inflamed and look like small bumps or pimples. This condition often stems from bacterial infections.

The affected areas may feel itchy and sore, sometimes becoming crusty sores if the infection spreads.

Most mild cases heal within a few days with basic home care, leaving no scars. Conversely, more severe or chronic infections may require prescribed medications for effective treatment.

If severe folliculitis goes untreated, it can cause permanent hair loss and scarring.

Some specific types of this condition include what’s commonly known as hot tub rash and barber’s itch. These variations have similar symptoms but occur from different exposure sources.

Symptoms

Skin Bumps

Folliculitis shows up as clusters of small bumps or pimples around hair follicles. These bumps may fill with pus, break open, and form crusts.

The affected skin often feels itchy, burns, or becomes painful and tender. Sometimes you’ll notice a single inflamed bump.

Simple folliculitis looks like small pus-filled bumps on the surface of the skin. These bumps form directly around hair follicles.

Hot Tub Rash

Hot tub rash creates round, itchy bumps that may turn into small, pus-filled blisters after exposure to contaminated water.

This rash typically appears 24โ€“48 hours after using poorly maintained hot tubs, pools, or water slides. The rash often looks worse in areas where swimwear trapped water against the skin.

Razor Bumps

Razor bumps predominantly impact individuals with curly hair who engage in shaving. These bumps form when cut hairs curve back and grow into the skin instead of outward.

The inward growth triggers inflammation, creating raised, sometimes painful bumps on the face, neck, or other shaved areas.

Boil Clusters

A carbuncle is a deeper skin infection that forms when several boils connect under the skin.

These painful, pus-filled, connected bumps create a larger area of infection than a single boil. Carbuncles may cause fever and make you feel generally unwell.

Folliculitis Varieties

Folliculitis comes in two main forms: superficial (affecting only part of the follicle) and deep (involving the entire follicle). Deep folliculitis is usually more serious.

Common types include:

Type Description Cause
Bacterial folliculitis Itchy, pus-filled bumps Usually Staphylococcus bacteria
Hot tub rash Round, itchy bumps appearing 1โ€“2 days after exposure Pseudomonas bacteria in poorly maintained water
Pityrosporum folliculitis Itchy, pus-filled bumps on back and chest Yeast infection
Gram-negative folliculitis Pustules around the nose and mouth Can develop during long-term antibiotic acne treatment

Less common types include:

  • Eosinophilic folliculitis: Intensely itchy, recurring patches on the face and upper body, often in people with HIV/AIDS
  • Boils and carbuncles: Deep bacterial infections of hair follicles
  • Shaving-related folliculitis: Affects people who shave regularly

Symptoms of folliculitis vary based on the type, depth of infection, and cause. Most cases involve some combination of bumps, pus, redness, and discomfort.

When to See a Doctor

Make an appointment with your healthcare provider if your symptoms don’t improve after 1โ€“2 weeks of home treatment, or if the condition spreads. Your doctor may prescribe stronger medication to treat the infection effectively.

Seek immediate medical attention if you notice:

  • Sudden increase in pain or redness
  • Fever
  • Chills
  • General feeling of being unwell

These symptoms may indicate that the infection is spreading and requires prompt medical care to prevent complications.

Causes

Folliculitis

Folliculitis develops when hair follicles become infected or damaged. The most common cause is bacterial infection, particularly from Staphylococcus aureus bacteria. However, several other factors can trigger this condition:

  • Microorganisms: Besides bacteria, viruses, fungi, and parasites, can infect follicles.
  • Physical damage: Injury to hair follicles creates openings for infection
  • Medications: Some drugs may trigger folliculitis as a side effect

Folliculitis appears in two main forms. Superficial folliculitis affects only the upper portion of the follicle and surrounding skin.

Deep folliculitis penetrates further into the follicle, sometimes affecting the entire structure. In some cases, doctors cannot identify a specific cause for the condition.

Risk Factors

Several factors can increase your chances of developing folliculitis:

Personal Habits and Clothing

  • Wearing tight clothes or items that trap heat and sweat (like rubber gloves or boots)
  • Soaking in poorly maintained hot tubs, whirlpools, or public pools
  • Damaging hair follicles through shaving, waxing, tight clothing, or certain hair styling methods

Medical Conditions

  • Diabetes
  • HIV/AIDS
  • Weakened immune system
  • Dermatitis (skin inflammation)
  • Excessive sweating (hyperhidrosis)

Medications

  • Corticosteroid creams
  • Prednisone
  • Long-term antibiotics for acne treatment
  • Certain chemotherapy medications

Complications

Folliculitis may lead to several complications if not properly treated:

  • Recurring infections that spread to nearby areas.
  • Permanent scarring of affected skin.
  • Changes in skin color (darker or lighter patches) that usually fade over time.
  • Permanent hair loss due to damage to hair follicles.

Ways to Prevent Folliculitis

Folliculitis prevention involves several practical steps that can help keep your skin healthy.

Regular skin washing with clean washcloths and towels is essential. Also, it’s important never to share these personal items with others.

Laundry habits play a key role in prevention. Wash towels, washcloths, and oil-soaked clothing in hot, soapy water frequently. This helps eliminate bacteria that might cause infection.

Reduce skin irritation factors:

  • Avoid tight clothing that rubs against your skin
  • Be careful with backpacks and helmets that cause friction
  • Let rubber gloves dry completely between uses (turn inside out, wash, rinse, and dry thoroughly)

Shaving recommendations:

  1. Consider growing facial hair, if possible
  2. Wash skin with warm water and a mild cleanser before shaving
  3. Use circular motions with a washcloth to lift embedded hairs
  4. Apply plenty of shaving lotion
  5. Shave in the direction your hair grows
  6. Avoid shaving too closely
  7. Use clean, sharp blades, rinsed between strokes
  8. Don’t shave the same area more than twice
  9. Apply moisturizer afterward
  10. Never share razors or shaving tools

Hair removal products offer alternatives to shaving, though they may also irritate sensitive skin. Choose products designed for your skin type and test them on a small area first.

Managing related conditions can prevent folliculitis outbreaks.

For example, if excessive sweating triggers your symptoms, change out of sweaty clothes promptly, bathe daily, and use antiperspirant.

Hot tub and pool safety:

  • Use only clean facilities
  • Remove swimwear and shower with soap after swimming
  • Wash swimsuits after each use
  • If you own a hot tub or heated pool, maintain proper chlorine levels

For recurring folliculitis, talk with your healthcare provider. They might recommend controlling bacterial growth in your nose with prescription antibacterial ointment for five days. Some patients benefit from body washes containing chlorhexidine.


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