What Is Folliculitis?
Folliculitis occurs when bacteria, fungi – even mites! - enter and infect a hair follicle, resulting in inflammation. The inflammation shows up on the skin as a red, sometimes itchy rash of raised bumps. These bumps may be filled with pus, which will drain if the bumps burst, whether from pressure or friction. Some people think these bumps are acne, but, although folliculitis can resemble acne, it's not the same thing and you don't treat it quite the same way.
Folliculitis can occur anywhere on the body where hair follicles are present, on men it's most often seen in the beard area. Yes, a man's routine daily shave can lead to a bad case of folliculitis, especially if he isn't good about changing his razor blade very often.
In women, folliculitis occurs most often on their legs and in the bikini area, often as a result of using depilatories (such as Nair) or shaving in those areas.
Typically, folliculitis bumps show up one to three days after exposure to the infection.
What Causes Folliculitis?
There are several types of folliculitis, and although the symptoms tend to be the same, each has a different cause. In all cases, what kicks things off is irritation of the hair follicle, which leaves it open to infection. Sources of irritation include shaving, wearing tight clothing that rubs against the skin, using substances that can block the hair follicles (like oil, heavy makeup, or cocoa butter), or having an infected wound. Follicles also can become vulnerable from long-term use of topical steroids and/or from the presence of autoimmune diseases such as diabetes and lupus. Regardless of how it starts, once irritation occurs, infection can set in. Here are the three main culprits behind folliculitis infections:
- Bacteria are the most common cause of folliculitis. The bacteria Pseudomonas aeruginosa, which loves warm, damp areas, is one culprit. Commonly referred to as "hot tub folliculitis," this results from swimming in pools or soaking in hot tubs or whirlpools that have not been properly treated with chlorine. This type of folliculitis usually appears on areas of the body where a bathing suit rubs against the skin, which causes irritation.
Another bacterial culprit is Staphyloccocus, which cause "barber's itch," usually following shaving. There also are many other bacteria responsible for folliculitis, but these two are the most common.
- Fungi. Fungal folliculitis is less common than the bacterial variety, but that doesn't help much if you happen to be the person dealing with it! Fungi called dermatophytes cause a condition known as Tinea barbae, which looks and acts like "barber's itch." The main difference between the two is the cause. Another type is Malassezia folliculitis, caused by yeast, which usually shows up on a person's chest, arms, and back.
NOTE: In most cases of folliculitis, you won't be able to tell if the cause is bacterial or fungal. A dermatologist can perform the tests needed to determine the underlying cause, but such research typically is reserved for cases when folliculitis doesn't go away on its own or doesn't respond to any of the treatments we discuss in this article.
- Mites. Another cause of folliculitis is mites, specifically Demodex folliculorum, a type of mite that is commonly present in the hair follicles of all healthy adults. Normally, they exist on our bodies without any problem. However, they can be present in over-large amounts on people with severely compromised immune systems, resulting in a specific type of folliculitis called Demodex folliculitis. This skin mite is also theorized to be a contributor to rosacea.
How to Treat Folliculitis
Now that you know the most common causes of folliculitis, how do you make it go away? First, as much as you might want to, do not pick at or scrub the red bumps on your skin. After all, irritation is what triggered the problem in the first place, and irritating your skin further is just going to make the folliculitis worse. As with so many other areas of skin care, "gentle" is the operative word!
Because most cases of folliculitis are caused by bacteria, it's important to keep your skin clean. Use a gentle cleanser on your face morning and night to wash away bacteria and soothe your skin. Using drying or irritating cleansers will only increase inflammation, making matters worse.
A non-irritating body wash will help if you have folliculitis from the neck down.
You also can try a leave-on product medicated with benzoyl peroxide to add an antibacterial punch to your skin-care routine.
Generally speaking, avoid heavy or overly creamy cleansers for your face and/or body and don't apply thick moisturizers to areas prone to folliculitis.
To ease the inflammation, you can use warm (but not hot) compresses to help draw out some of the pus that builds up in the folliculitis bumps.
In many cases, folliculitis goes away on its own, although it takes time. If you have folliculitis for more than a few weeks and it doesn't get better or respond to over-the-counter treatments, go see your doctor, who can diagnose the specific cause of the folliculitis and prescribe a treatment to knock out the problem quickly. Oral and topical antibiotics are the most common fixes. If fungus is the cause, topical or oral antifungal agents are prescribed. A dermatologist can also prescribe medication to fight the mites that could be causing the problem.
Although it can be difficult to avoid getting folliculitis, keeping your skin clean and avoiding irritating skin-care products will help a lot. If you do wind up getting it, remember—hands off and don't scrub! Use gentle skin-care products, have a little patience, and if that doesn't work, see your doctor. As bad as it might seem, clear skin can be in your future!
Sources: Clinical Dermatology, 5th Edition, Mosby Elsevier, 2009, Chapters 1 and 9; Principles and Practice of Infectious Diseases, 7th Edition, Elsevier Churchill Livingstone, 2009, Chapter 90; Sauer's Manual of Skin Diseases, 49th Edition, McGraw-Hill, 2010, pages 123–124; Fitzpatrick's Dermatology in General Medicine, 7th Edition, McGraw-Hill, 2008, pages 1698–1699; and Acta Dermato-Venereologica, volume 89, 2002, pages 3–6.