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Folliculitis

Published by Bupa's health information team, December 2008.

This factsheet is for people who have folliculitis, or who would like information about it.

Folliculitis is a condition where hair follicles become inflamed, causing pustules and red, painful bumps on the skin.

• About folliculitis
• Symptoms of folliculitis
• Complications of folliculitis
• Causes of folliculitis
• Diagnosis of folliculitis
• Treatment of folliculitis
• After your treatment
• Further information
• Questions and answers
• Related topics
• Sources

About folliculitis

A hair follicle is a pouch in the skin from which hair grows. If it becomes inflamed it is known as folliculitis. Folliculitis is common, and can affect people at any age. It tends to be more common in humid climates.

Folliculitis is commonly caused by a bacterial infection, but other physical factors can also cause it or make it more likely.

The hair follicle in the skin

Symptoms of folliculitis

Folliculitis causes itchy or painful redness in the affected area. Small papules (red swellings) or pustules, around one to 5mm wide, then develop in hair follicles. A hair will pierce the papule or pustule. Usually several follicles will be affected in an area. A crust sometimes forms over pustules.

Folliculitis can develop in any area where hair grows but usually occurs on the scalp, legs, buttocks or the beard area on your face.

If you think you have folliculitis, go and see your GP for advice.

Complications of folliculitis

Folliculitis usually affects the upper portion of the hair follicle, near the surface of the skin. However, if the infection is deeper there will be more redness extending between follicles. The redness can join up, creating a larger area of irritation that won't go away, or that keeps coming back.

If folliculitis persists, the infection may go deeper into the skin, causing boils, or a more widespread infection deep in the skin (cellulitis).

In severe cases, folliculitis can cause scarring and, if the hair follicle is damaged, permanent hair loss.

Causes of folliculitis

The bacterium that most commonly causes folliculitis is Staphyloccocus aureus. However, it can also be caused by other types of bacteria. 'Hot tub' folliculitis often develops after using pools, whirlpools or spas that don't have enough chlorine in. This is caused by a bacterium called Pseudomonas aeruginosa. It can also be caused by a type of yeast called Pityrosporum.

Not all folliculitis is due to infection. It can also be caused by physical factors such as friction from tight clothing, shaving, or by wound dressings covering the skin. Other rare conditions can also give rise to non-infective folliculitis.

Folliculitis often happens in the beard area in men, and may be due to hair curling back into the skin. This is known as pseudofolliculitis as it isn't due to an infection.

There is some research to suggest that having diabetes makes infected folliculitis more common.

Diagnosis of folliculitis

If you think you have folliculitis and it doesn't clear up on its own, go and see your GP. He or she will be able to diagnose you by looking at the area affected.

If the folliculitis keeps coming back, your GP may want to take a swab of the affected area. This is to find out what type of bacteria is causing the infection.

Treatment of folliculitis

Folliculitis usually clears up quickly and it may get better on its own. However, depending on how severe it is, your GP may recommend some medicines to help clear up the infection.

Antiseptics

Mild folliculitis can often be treated by washing the affected area every day with an antiseptic product. Your GP will prescribe you a suitable product. These will usually contain an antiseptic such as chlorhexidine (eg Hibiscrub) or triclosan (eg Aquasep). These can come as lotions, creams, soap substitutes or bath additives.

Antibiotic creams

Your GP may prescribe you a cream or ointment containing fusidic acid (eg Fucidin) if the folliculitis affects just a small area. This is a type of antibiotic that kills the bacteria infecting your hair follicles. He or she may use other antibiotic creams or ointments, such as mupirocin (eg Bacticab).

Antibiotic tablets

If the folliculitis is severe, or keeps coming back, your GP may prescribe you antibiotic tablets. Some examples include flucloxacillin and erythromycin, but he or she may recommend other types.

After your treatment

If the folliculitis is being caused by something in particular, such as friction from tight jeans, this needs to be addressed to help the folliculitis heal and to stop it from coming back.

If the folliculitis keeps coming back, it may be that the bacterium Staphylococcus aureus has colonised your nasal area. This can cause re-infection. It can usually be treated with an ointment. Alternatively, shaving implements or creams you are using may be colonised with the bacteria. They will need to be replaced, or the equipment cleaned thoroughly after use with boiling water or antiseptic solution. The source of the infection needs to be targeted to prevent folliculitis coming back.

Further information

• British Association of Dermatologists
  0207 383 0266
  www.bad.org.uk

Related topics

• Acne

Sources

• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2005: 669
• Sladden MJ, Johnston GA, More common skin infections in children. BMJ, 2005; 330(7501): 1194-1198. www.bmj.com
• Boils and paronychia. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 25 June 2008
• Kumar P, Clark M, Clinical Medicine. 6th edition ed. London: Elsevier Saunders, 2005: 1319
• Folliculitis barbae. British skin foundation. www.britishskinfoundation.org.uk, accessed 25 June 2008
• Sycosis barbae. GP Notebook. www.gpnotebook.co.uk, accessed 12 June 2008
• Personal communication, Dr Ardern-Jones M, BSc, MBBS, MRCP, Dphil, Consultant Dermatologist, Southampton University NHS Trust and Spire Southampton Hospital, 20 August 2008

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: December 2008