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Disease: Folliculitis Folliculitis
Category: Dermatological diseases

Disease Definition:

When someone's hair follicles become infected, usually with Staphylococcus aureus or other types of bacteria, folliculitis occurs. Hot tub folliculitis and barber's itch are some of the types of folliculitis. Mild folliculitis could be uncomfortable and embarrassing, and when the infection is severe, it could cause permanent hair loss and scarring.


Generally, the infection appears as small and white-headed pimples around one or more of the hair follicles, the tiny pockets from which each hair grows. Mostly, folliculitis is superficial and it could itch; in some cases, it could also be painful. Usually, in a few days, superficial folliculitis clears on its own; however, medical treatment will be needed in case the folliculitis is deep or recurring.

Work Group:

Symptoms, Causes


Depending on the type of the infection, the signs and symptoms of folliculitis could vary. Some of the superficial folliculitis types which include those that affect the upper part of the hair follicle could result in:


  • Red and inflamed skin
  • Itchiness or tenderness
  • Clusters of small red bumps that develop around hair follicles
  • Pus-filled blisters that break open and crust over


Affecting the entire hair follicle, deep folliculitis starts deeper in the skin surrounding the hair follicle. Some of the signs and symptoms of this type include:


  • Pain
  • A large swollen bump or mass
  • Possible scars after the infection clears
  • Pus-filled blisters that break open and crust over



These are the superficial forms of folliculitis:


Pseudomonas folliculitis:

Also called hot tub folliculitis, the bacteria that cause this form of folliculitis thrive in a wide range of environments, including hot tubs whose chlorine and pH levels are not well regulated. A rash of red, round and itchy bumps will appear within eight hours to five days of exposure to the bacteria, which could later develop into small pus-filled blisters, also called pustules. In areas where the swimsuit holds contaminated water against the skin, the rash is likely to be worse.


Staphylococcal folliculitis:

This is a common type of folliculitis marked by itchy, white, pus-filled bumps that could occur anywhere on the body where hair follicles are present. This type is called barber's itch when it affects a man's beard area. When hair follicles become infected with Staphylococcus aureus (staph) bacteria, this type of folliculitis occurs. Despite the fact that staph bacteria live on a person's skin all the time, however, they only cause problems when they enter the body through a cut or other wound, which could occur with an injury to the skin, through scratching or shaving.


Tinea barbae:

This type of folliculitis develops in the beard area in men; it is caused by a fungus instead of a bacterium and results in itchy, white bumps. The surrounding skin could also become reddened. A more serious and inflammatory form of the infection will appear as pus-filled nodules, which will eventually form a crust. This type occurs with fever and swollen lymph nodes.


Herpetic folliculitis:

The herpes infection could sometimes spread to neighboring hair follicles when a man shaves through a cold sore, which is a small and fluid-filled blister caused by the herpes simplex virus.


Pityrosporum folliculitis:

Caused by the yeast-like fungus, this type is especially common in teens and adult men. It produces chronic, red and itchy pustules on the back and chest and in some cases, on the shoulders, upper arms, face and neck.


Pseudofolliculitis barbae:

This type, which is an inflammation of the hair follicles in the beard area, affects men when shaved hairs curve back into the skin. This could lead to inflammation and in some cases, to keloid scars, which are dark raised scars on the neck and face.



These are the types of deep folliculitis:


Boils and carbuncles:

When hair follicles become deeply infected with staph bacteria, boils and carbuncles may occur. Usually, a boil appears suddenly and looks like a painful pink or red bump. The skin that surrounds it could also be red and swollen. The bump fills with pus, and before rupturing and draining, it grows larger and more painful. Despite the fact that a large boil may leave a scar, however, small boils usually heal without scarring. Occurring on the back of the neck, shoulders, back or thighs, a carbuncle is a cluster of boils, which causes a deeper and more severe infection than a single boil does. Because of this, they are more likely to leave scars, and develop and heal more slowly.


Gram-negative folliculitis:

In some cases, when a person's receiving long-term antibiotic treatment for acne, this type of folliculitis may develop. An overgrowth of harmful organisms (gram-negative bacteria) is sometimes caused by antibiotics because they alter the normal balance of bacteria in the nose. Usually, the flora in the nose returns to normal after the antibiotics are stopped, and this situation doesn't cause any problems in most people. However, in some cases, gram-negative bacteria could spread causing new and sometimes severe acne lesions.


Eosinophilic folliculitis:

This type of folliculitits is marked by recurring patches of inflammed and pus-filled sores, which usually occur on the face and sometimes on the back or upper arms. This type is usually seen in people with HIV. These sores could itch intensely and leave areas of darker than normal skin when they heal, a condition called hyperpigmentation. They could also spread. Even though it is thought that the same yeast-like fungus which is responsible for pityrosporum folliculitis is involved in this kind of folliculitis, however, its exact cause is still not known.


Usually, without any treatment, mild cases of folliculitis clear up. However, a person should see a doctor in case the infection does not clear in spite of home treatment, appears to spread or recurs frequently. In order to help control the problem, a person may be prescribed antibiotics or antifungal medications.


Bacteria, viruses or fungi could infect the hair follicles and cause folliculitis. However, the staphylococcus aureus bacterium is the most common cause of folliculitis.


Although follicles could appear anywhere on the body except for the palms, soles and mucous membranes, including the lips, however, they are densest on the scalp. Follicles could become susceptible to invasion in case they're damaged. Some of the most common causes of follicle damage include:


  • Covering the skin with adhesive tape or plastic dressings.
  • Friction from tight clothing or shaving
  • Injuries to the skin, including surgical wounds or abrasions.
  • Excessive perspiration
  • Inflammatory skin conditions, such as acne and dermatitis.



Although complications usually don't occur with mild cases of folliculitits, however, if they do occur, they may include:


  • Spreading or recurrent infection
  • Large and itchy patches of staph infection on the skin (plaques)


Some of the complications of severe folliclulitis may include:



When a number of boils develop under the skin, this condition occurs. Boils usually become large and painful as they fill with pus, despite the fact that they start as small red bumps.



When a swollen red area of skin that feels hot and tender appears and spreads rapidly, it means that the person has the potentially serious bacterial infection known as cellulitis. The initial infection is usually superficial; however, when it develops it could affect the tissue underlying the skin or it could spread to the bloodstream and lymph nodes.


Destruction of the hair follicle:

This condition leads to a permanent loss of hair.



Some severe cases of folliculitis could leave patches of skin that are darker than normal or hypertrophic or keloid scars, which are thick and raised scars.


Although mild cases of folliculitis usually go away on their own, however, persistent or recurring cases will require treatment. Depending on the type and severity of the infection, the appropriate type of therapy will be determined.


Pseudomonas folluculitis:

Also called hot tub folliculitis, this condition requires specific treatment only in some rare cases. Despite this, in order to help relieve itching, the doctor may prescribe an oral or topical medication (anti-pruritic). Oral antibiotics will be required for more-severe cases.


Staphylococcal folliculitis:

Treatment for this condition may consist of oral or topical prescription antibiotics. Until the infection heals, the doctor may recommend avoiding shaving the affected area. However, if the person must shave, they should use a clean razor blade every time or an electric razor.


Pseudofolliculitis barbae:

This condition is usually treated with self-care measures. One thing that could help is shaving with an electric razor that doesn't cut as closely as a razor blade does. The person should massage the beard area with a warm and moist washcloth or facial sponge if they are going to use a blade, in order to lift the hairs so that they could be cut more easily. Instead of a shaving cream, they should use a shaving gel, and shave in the direction of the hair growth. Before applying a moisturizing after-shave, the face should be rinsed thoroughly with warm water.


Tinea barbae:

Oral anti-fungal medications could effectively treat this infection, particularly the inflammatory form.


Pityrosporum folliculitis:

The most effective treatments for this type of folliculitis are oral or topical antifungals. A person may be recommended using topical ointments indefinitely because this condition could return once the course of oral medication is finished. Antibiotics could make the infection of pityrosporum folliculitis worse by upsetting the normal balance of bacteria on the skin, which means that they are not helpful in treating this condition.


Herpetic folliculitis:

This condition could clear up without any treatment if the person is a healthy adult. However, he/she may be prescribed an oral antiviral medication such as famciclovir, valacyclovir  or acyclovir, in the case of experiencing frequent cold sores, or if he/she is living with HIV/AIDS. These drugs cannot prevent this condition from recurring despite the fact that they clear the infection.


Boils and carbuncles:

In order to relieve pain, speed recovery and help lessen scarring, a large boil or carbuncle could be drained by making a small incision. When a deep infection cannot be cleared, it should be covered with sterile gauze, so that the pus could continue draining. In some cases, in order to help heal severe or recurrent infections, a person may be prescribed antibiotics.


Gram-negative folliculitis:

Usually, this type of folliculitis is treated with certain antibiotics or with isotretinoin , despite the fact that this particular condition results from long-term antibiotic therapy for acne.


Eosinophilic folliculitis:

Although topical corticosteroids are usually the treatment of choice for this condition, however, a number of therapies could effectively treat it. In case someone has a severe infection, they may be prescribed a short course of oral corticosteroids. Corticosteroids should be used for as brief a time as possible, because all steroids could have serious side effects. Someone may be prescribed topical steroids combined with oral antihistamines, in case they're living with HIV\AIDS and have a mild case of eosinophilic folliculitis. Treatment with isotretinoin  for several months is required for more severe cases.


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