With common names
like hot tub folliculitis and barber'sitch, folliculitis may sound more like a bad joke than a
skin disorder. But this infection of the hair
follicles is no laughing matter. Severe cases may
cause permanent hair loss and scarring, and even
mild infections can be uncomfortable and
usually appears as small, white-headed pimples
around one or more hair follicles - the tiny pockets
from which each individual hair grows. Most
infections are superficial, affecting just the upper
part of the follicle, and although they may itch,
they're seldom painful. The pimples can occur almost
anywhere on your body, but they are especially
common on the face, scalp, thighs, legs and in the
starts with damage to your hair follicles - either
from a blockage of the follicles or from friction
caused by clothing or shaving. Once injured, the
follicle is susceptible to infection by bacteria,
yeast or fungi. Barber's itch, for example, is a
bacterial infection that's aggravated by shaving.
Tinea barbae - roughly, barber's itch in Latin - is
a similar infection caused by a fungus.
In many cases, the
infection clears on its own. When it persists, your
doctor may recommend treatment with a topical
antibiotic. For more severe infections involving the
entire follicle, you may need oral antibiotics or
broad-spectrum antifungal agents.
Signs and symptoms
The signs and symptoms of folliculitis
vary, depending on the type of infection. In superficial forms of the
disorder, small pimples develop around one or more hair follicles. One
way to distinguish a follicular pimple from acne is that with a
follicular pimple you often can see the hair shaft at the center of the
lesion. The pimples sometimes contain pus (pustules), and they may crust
over or be surrounded by an area that's red and inflamed. The infection
may itch or be somewhat tender, but it usually isn't painful. Deep
folliculitis, which affects the entire hair follicle, can cause more
severe signs and symptoms, including large, painful, pus-filled pimples
that may leave scars when they heal.
Superficial forms of
- Pseudomonas folliculitis (hot tub
folliculitis). You really do acquire this form of folliculitis from
hot tubs — or at least from those contaminated with pseudomonas
bacteria. The bacteria thrive in a wide range of environments,
including wooden tubs with chlorine and pH levels that aren't well
regulated. About 12 to 48 hours after you're exposed, you're likely
to develop a number of red, round, itchy bumps that later may
develop into small pus-filled blisters (pustules). The rash is
likely to be worse in areas where your swimsuit holds contaminated
water against your skin. You're at increased risk of infection if
you have diabetes, a history of skin infections, or open cuts or
- Barber's itch. This type of
folliculitis is marked by itchy, white, pus-filled lumps in the
beard area in men and sometimes on the legs or underarms in women.
It occurs when hair follicles that have been irritated by shaving
become infected with Staphylococcus aureus (staph) bacteria.
Although staph bacteria live on your skin all the time, they
generally cause problems only when they enter your body through a
cut or other wound.
- Tinea barbae. Caused by a fungus (Trichophyton
verrucosum or Tricophyton mentagrophytes) rather than by bacteria,
this type of folliculitis also develops in the beard area in men.
It's highly contagious and got its name because in the past it was
spread by barbers who used contaminated razors. Like barber's itch,
tinea barbae causes itchy, white bumps. The surrounding skin may
also become reddened. A more serious, inflammatory form of the
infection appears as pus-filled nodules that eventually form a crust
and that may occur along with swollen lymph nodes and fever.
- Pseudofolliculitis barbae. An
inflammation of the hair follicles in the beard area,
pseudofolliculitis barbae affects African American men and others
with curly beards. It develops when shaved hairs curve back into the
skin, leading to inflammation and sometimes to dark raised scars (keloid
scars) on the face and neck.
- Pityrosporum folliculitis.
Especially common in young and middle-age adults, pityrosporum
folliculitis produces chronic, red, itchy pustules on the back and
chest and sometimes on the neck, shoulders, upper arms and face.
It's caused by infection with a yeast-like fungus, Malassezia furfur,
which is similar to the fungus that causes dandruff.
- Herpetic folliculitis. Shaving
through a cold sore — a small, fluid-filled blister caused by the
herpes simplex virus — can sometimes spread the herpes infection to
your hair follicles.
Types of deep
- Gram-negative folliculitis. This
sometimes develops in people receiving long-term antibiotic
treatment for acne. Antibiotics alter the normal balance of bacteria
in the nose, leading to an overgrowth of harmful organisms
(Gram-negative bacteria). In general this doesn't cause problems,
and the flora in the nose return to normal once antibiotics are
stopped. In a few people, however, Gram-negative bacteria spread to
the cheeks, chin and jaw line, where they cause new,
sometimes-severe acne lesions.
- Boils and carbuncles. These occur
when hair follicles become deeply infected with staph bacteria. A
boil usually appears suddenly as a painful pink or red bump about
1/2 inch in diameter. The surrounding skin may also be red and
swollen. Within 24 hours, the bump fills with pus. It grows larger
and more painful for five to seven days, sometimes reaching
golf-ball size before it develops a yellow-white tip that finally
ruptures and drains. Boils generally clear completely in about two
weeks. Small boils usually heal without scarring, but a large boil
may leave a scar. A carbuncle is a cluster of boils that often
occurs on the back of the neck, shoulders or thighs, especially in
older men. Carbuncles cause a deeper and more severe infection than
a single boil. As a result, they develop and heal more slowly and
are likely to leave scars.
- Eosinophilic folliculitis. Seen
primarily in HIV-positive people, this type of folliculitis is
characterized by recurring patches of inflamed, pus-filled sores,
primarily on the face and sometimes on the back or upper arms. The
sores usually spread, may itch intensely, and often leave areas of
darker than normal skin (hyperpigmentation) when they heal. The
exact cause of eosinophilic folliculitis isn't known, although it
may involve the same yeast-like fungus responsible for pityrosporum
Every hair on your body grows from a
follicle, a small pocket under the skin. Although follicles are densest
on your scalp, they occur everywhere except your palms, soles and mucous
membranes such as your lips.
Each follicle is attached to a small
muscle. When you're cold or frightened, the muscle contracts, raising
the hairs above the level of your skin and giving the appearance of
"goose bumps." Just above these muscles are sebaceous glands that
produce an oil (sebum) that lubricates your skin and coats each hair
shaft. Sebum is carried to the follicles and skin in tiny ducts.
Normally, the follicles carry out these
functions with few problems. But when they're damaged, they may be
invaded by viruses, bacteria and fungi, leading to infections such as
The most common causes of hair follicle
- Friction from shaving or tight
- Excess perspiration, which can
block the follicles
- Inflammatory skin conditions,
including dermatitis and acne
- Injuries to your skin such as
abrasions, surgical wounds or abscesses — red, painful, swollen
areas of infection
- Use of plastic dressings or
- Exposure to coal tar, pitch or
creosote — common among roofers, mechanics and oil workers
Anyone can develop folliculitis, but
certain factors make you more susceptible to the condition. These
- Medical conditions that reduce
your resistance to infection, such as diabetes, chronic leukemia,
organ transplantation and HIV/AIDS
- A pre-existing skin condition such
as acne or dermatitis
- Trauma to your skin from surgery
or an abscess
- Long-term antibiotic therapy for
- Topical corticosteroid therapy
- Obesity — folliculitis is more
common in people who are overweight
- Living in a warm, humid climate
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