Folliculitis is a common skin condition that occurs when hair follicles become inflamed due to infection, irritation, or blockage.
Folliculitis is a common skin condition that occurs when hair follicles become inflamed due to infection, irritation, or blockage.
The most frequent cause is a bacterial infection, though fungi and viruses can also be responsible. It typically appears as a small cluster of red bumps or pustules, often resembling acne, and may cause itching and soreness.
While mild cases of folliculitis usually resolve on their own without complications, persistent or severe folliculitis may require medical treatment.
An inflammation of the hair follicle, folliculitis can occur anywhere on your body that grows hair. Commonly affected areas include:
Face
Scalp
Chest
Back
Buttocks
Thighs
Depending on the underlying cause and/or its location on the body, folliculitis may be referred to by other different names, such as:
Hot tub rash: Typically caused by Pseudomonas bacteria from contaminated water
Razor bumps: Irritation from shaving, often seen on the face, neck, or bikini area
Barber’s itch: A bacterial infection affecting the beard area
Scalp folliculitis: Inflammation of hair follicles in the scalp, sometimes linked to fungal or bacterial infection
Folliculitis typically causes clusters of small red bumps or tiny pus-filled bumps around hair follicles. These may be itchy, tender, or cause a burning sensation. The affected skin can appear red and inflamed, and in some cases, the pustules may develop into sores and scabs.
Common signs and symptoms of folliculitis include:
Small red bumps or tiny pus-filled blisters around hair follicles
Itchy or burning skin
Tenderness in the affected area
Inflamed skin (red, swollen, and warm to the touch)
Temporary hair loss in the affected area
While folliculitis is a superficial condition involving the hair follicles, furuncles (boils) and carbuncles are deeper follicle infections that extend into the surrounding skin.
Furuncles (boils) - develop when a hair follicle becomes deeply infected, leading to a large, painful lump filled with pus.
Carbuncles - are clusters of furuncles that form a larger infected area, often with multiple drainage points.
Unlike folliculitis, furuncles and carbuncles may cause fever and require medical treatment, such as drainage or antibiotics.
Acne and folliculitis can look similar, but they have different causes and tend to appear in different locations on the body.
Acne develops when pores become clogged with excess sebum and dead skin cells, often in the presence of bacteria. This can lead to different types spots, including:
Whiteheads
Blackheads
Pimples
The most common location of acne is the face, but it may also affect other areas, such as your back, chest, or shoulders.
Folliculitis, on the other hand, refers to inflammation of a hair follicle. It can be caused by various factors, including infection, hair removal techniques, friction from tight clothing, poor hygiene, a weakened immune system, and certain medications. Folliculitis can appear anywhere hair follicles are present, including the scalp, arms, legs, buttocks, and back. It is less common on the face unless related to shaving.
Folliculitis occurs when hair follicles become inflamed due to infection, irritation, or blockage. It can be triggered by bacteria, fungi, shaving, friction, or environmental factors. While some cases involve infection, others result from mechanical irritation or occlusion.
While folliculitis can result from infection, irritation, or follicle blockage, the underlying causes vary.
Below are the most common triggers:
Bacterial infections:
Staphylococcus aureus (aka Staph): The most common bacterial cause of folliculitis. This bacteria normally lives on the skin but can invade follicles through minor cuts, shaving, or skin irritation.
Hot tub folliculitis: Caused by Pseudomonas aeruginosa, a bacterium found in poorly maintained hot tubs or pools. Unlike bacterial folliculitis caused by Staph, it does not require prior irritation or follicle blockage; the bacterium can invade directly. It usually appears 12-48 hours after exposure as an itchy, red rash with small pus-filled bumps.
Fungal and yeast overgrowth:
Malassezia (Pityrosporum) folliculitis is caused by an overgrowth of Malassezia yeast within hair follicles. It does not require prior follicle damage and is often triggered by excessive sweating, oily skin, humidity, and immune system imbalances. It most often affects the chest, back, and shoulders.
Fungal folliculitis: A dermatophyte infection of hair follicles, commonly affecting the scalp, chest, and back. In the bearded area (tinea barbae), it may cause more severe inflammation and crusting.
Mechanical irritation and hair removal:
Shaving, plucking, and waxing: Removing hair can damage follicles, leading to inflammation or bacterial entry. Plucking and waxing, in particular, can cause irritation and increase the risk of ingrown hairs, which may develop into folliculitis.
Friction from clothing and equipment: Tight clothing, helmets, and sports gear can cause heat and sweat buildup, irritating follicles.
Insect bites or minor skin injuries: Bites, scratches, or small wounds can irritate hair follicles, causing inflammation. If bacteria enter the follicle, it may lead to infection and pus-filled bumps.
Environmental and chemical triggers:
Occlusive skincare and hair products: Thick, oil-based moisturizers, sunscreens, and pomades can clog follicles and trigger folliculitis.
Heat, sweat, and humidity: Excessive sweating without proper cleansing can contribute to follicular blockage.
Sunlight exposure (actinic folliculitis): A rare form triggered by ultraviolet exposure, appearing four to 24 hours after exposure to sunlight.
Medication-induced folliculitis: Certain medications can trigger folliculitis. These include corticosteroids, androgens, lithium, immunosuppressants, and some anticonvulsants.
Folliculitis is a common condition that can develop in anyone, but some people may be more prone to developing it than others.
Certain factors can increase the likelihood of developing folliculitis. These include:
Weakened immune system: Individuals with conditions such as HIV, cancer, diabetes or those undergoing chemotherapy are more susceptible to folliculitis, due to reduced ability to fight skin infections.
Medications that alter skin health: Various medications can affect skin health, such as:
Long-term topical corticosteroids: These can thin the skin, making it more susceptible to irritation and bacterial infections.
Prolonged antibiotic use: Using antibiotics over a longer period can disrupt the skin’s microbiome.
Immunosuppressive drugs: These drugs can increase susceptibility to bacterial and fungal infections in hair follicles.
Lifestyle and hygiene factors: Various habits related to lifestyle and personal hygiene can also play a role. This includes:
Frequent shaving, waxing and plucking: Hair removal methods like shaving, waxing, and plucking can irritate follicles, increasing the risk of ingrown hairs and folliculitis, especially in those with coarse or curly hair.
Tight clothing and excessive sweat: Friction from tight clothing can irritate hair follicles, while tapped moisture and heat create an environment for bacteria or fungi to thrive.
Hot tub use: Poorly maintained hot tubs or whirlpools can harbor Pseudomonas aeruginosa, which can lead to hot tub folliculitis.
Obesity: Increased skin folds create areas of friction and additional moisture, providing a favorable environment for bacteria to grow.
Underlying skin conditions: Certain skin conditions, such as eczema, can weaken the skin barrier, increasing susceptibility to folliculitis.
Folliculitis is usually recognizable and easily identified without running any specific tests. It can often be diagnosed by your primary healthcare provider. However, If you experience frequent or severe cases, your provider may refer you to a dermatologist for further evaluation.
The process for diagnosing folliculitis typically involves a clinical evaluation In some cases, additional testing to determine the underlying cause may be recommended. The diagnostic process may look like this:
Medical history: Your healthcare provider will ask you about your symptoms as well as any recent activities or factors that may have triggered folliculitis. These might include shaving or other hair removal habits, hot tub use, excess sweating, and medication use. They may also inquire about any underlying medical conditions that may increase susceptibility to folliculitis.
Physical examination: The doctor will examine the affected area to identify characteristic signs of folliculitis, such as red bumps or pustules around hair follicles.
Skin culture: If the folliculitis is recurrent or does not respond to treatment, your doctor may take a swab from a pustule to identify the specific bacteria, fungi, or other pathogen involved and determine if they are resistant to any antibiotics.
Biopsy: In rare cases, a skin biopsy may be performed if the folliculitis does not improve with treatment or if another skin condition with similar symptoms needs to be ruled out.
Most cases of folliculitis heal on their own without medical interventions. However, if symptoms persist or worsen, treatment may be necessary to relieve discomfort and prevent complications.
The appropriate treatment for folliculitis depends on its severity and underlying cause. Mild cases often improve with self-care measures, while more severe or recurrent cases may require prescription medications. For deeper infections resulting in furuncles (boils) or carbuncles, additional medical intervention may be necessary.
Self-care for mild folliculitis may include:
Using warm compresses: Applying a warm, moist compress for 10-15 minutes several times a day can help soothe irritation and promote drainage of pustules.
Keeping the area clean and dry: Keeping the affected area clean and dry can help prevent bacterial growth. Wash the skin with mild antibacterial soap and gently pat dry.
Avoiding potential irritants: It’s best to refrain from shaving or using harsh skincare products on the affected area until the skin has healed.
For more severe cases, your doctor may prescribe or recommend medication treatment options such as:
Topical antibiotics: Creams or ointments containing antibiotics such as mupirocin or clindamycin are often effective against bacterial folliculitis.
Oral antibiotics: For severe or widespread infections, oral antibiotics may be prescribed.
Antifungal treatments: Topical or oral antifungal medications may be used for fungal folliculitis.
Corticosteroid creams are generally not used to treat infectious folliculitis, as they may worsen bacterial or fungal infections. However, for non-infectious folliculitis — such as cases caused by irritation or friction — a doctor may prescribe a mild steroid cream to help reduce inflammation and itching.
If folliculitis progresses to deep painful boils (furuncles and carbuncles), a healthcare provider may need to drain the pus to relieve pressure and promote healing.
For recurrent cases, laser hair removal can permanently reduce the number of hair follicles, lowering the risk of future folliculitis outbreaks.
Taking steps to protect your skin during hair removal and maintaining good hygiene can help reduce the risk of folliculitis.
To minimize irritation and reduce the risk of infection, the American Academy of Dermatology recommends the following steps when shaving.
Wet the hair before shaving. This will help to soften your hair. A great time to shave is right after getting out of the shower while your skin is still warm and moist.
Apply a shaving cream or gel. You may want to look for formulations specifically for sensitive skin if you are prone to skin irritation.
Shave in the direction your hair grows. This will help to prevent ingrown hairs and folliculitis.
Regularly rinse your blade. Rinse your blade after each pass. It’s a good idea to throw away disposable razors after about five to seven shaves.
Store your razor in a dry place. This will help ensure the blade dries completely, which will help prevent the growth of bacteria.
Maintain good hygiene. Wash skin daily using a mild cleanser. Additionally, ensure razors, towels, and sports gear are clean before use.
Apply soothing lotions or gels. Lotions or gels with soothing ingredients like aloe vera may help reduce skin irritation after shaving.
Wear breathable clothing. Opt for loose-fitting, natural fabrics to minimize heat and moisture buildup on your skin.
Avoid sharing personal items. Avoid sharing razors, washcloths, or clothing to prevent bacterial or fungal spread.
Consider an electric razor. Electric razors generally don’t shave as close as manual razors do. This may help in reducing shaving-related irritation.
Practice good overall lifestyle habits: Maintain a healthy diet, exercise regularly, and avoid heavy drinking or smoking to support your immune and overall health.
According to the Centers for Disease Control and Prevention (CDC), ways that you can reduce your chances of developing hot tub folliculitis include:
Removing your swimsuit and showering with soap after getting out of a hot tub.
Washing your swimsuit after each use.
Using test strips to test the water to ensure adequate disinfectant levels and pH.
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