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Folliculitis: Causes, Symptoms and Treatment
Folliculitis is a common skin condition that causes inflammation of the hair follicles. It’s usually caused by a bacterial or fungal infection. Folliculitis appears as red spots, often with pustules (small bumps containing fluid or pus) on the surface of the skin. It can also cause a raised, itchy and sometimes painful rash. While folliculitis usually clears up on its own, you may need treatment if it’s not clearing up or bothering you too much.
Last reviewed: 21/03/2023 by Dr Babak Ashrafi
Contents
What is Folliculitis?
Folliculitis is a common skin condition often caused by a bacterial or fungal infection that causes your hair follicles to become inflamed. This can result in a raised, itchy, and painful rash. Folliculitis usually clears up on its own, but if you’re finding it unmanageable or doesn’t go away, there are treatments available that can help.
How common is Folliculitis
Folliculitis is considered a common skin condition. It’s usually found in people who have a history of diabetes, obesity or a weak immune system. It can also be caused by extended antibiotic use.
Types of Folliculitis
There are two different types of folliculitis: superficial and deep.
Superficial folliculitis can cause pustules (small bumps containing fluid or pus) on the skin, usually in areas you get hair, and only affects the upper part of the hair follicle and the surrounding skin. It is always caused by the bacteria Staphylococcus aureus and is most common on the scalp, face, arms, and legs. It can cause yellow-white, pinhead pustules that may itch or burn.
Deep folliculitis affects a larger proportion of the hair follicle or even all of it. It can cause boils and is usually found on the waist, buttocks, groin, or under the arm.
What are the symptoms of Folliculitis?
The symptoms of folliculitis include:
- groups of small, red pimples around hair follicles
- pus-filled blisters that open and form a crust
- itchy, burning skin
- painful skin
- inflamed bumps that look like boils
What are the early signs of Folliculitis?
The first sign of folliculitis is usually a skin rash with patches of small red bumps or pimples with yellow or white pimples.
What does Folliculitis look like?
Some types of folliculitis can look like small red, pimple-like bumps that can have yellow or white heads on them. Other types can cause large blisters that break open and crust over.
What does Folliculitis feel like?
Folliculitis can feel itchy, inflamed and painful, or you may not feel anything if it’s mild.
How long does Folliculitis last?
Most people who experience folliculitis find that it improves within 7 to 10 days. If it does not, you can reach out to your doctor to get treatment to help manage the condition.
Folliculitis complications
Most cases of folliculitis clear up on their own or with mild treatment. It rarely causes any long-term complications, but it may cause:
- recurrent infection
- boils under your skin to form
- dark skin patches or scarring
- hair loss because of permanent damage to the affected hair follicle
When should I talk to a doctor about my Folliculitis?
Most cases of folliculitis won’t need medical attention, but if you have skin irritation with a high temperature (fever), a rash that is spreading, or pus-filled bumps on your skin that smell, you should speak to a doctor
What causes Folliculitis
Folliculitis is often caused by hair follicles becoming infected with bacteria causing superficial or deep folliculitis. Fungi or viruses can also cause it. Some of the common causes of folliculitis are listed below.
Hot tub folliculitis
Hot tub folliculitis is caused by the bacteria Pseudomonas aeruginosa and occurs when you spend too much time in a hot tub that hasn’t been cleaned or drained properly. It is sometimes known as hot tub rash and usually appears on your skin a few days after sitting in a poorly maintained hot tub. It can also be caused by swimming in a contaminated lake or a swimming pool that hasn’t been cleaned properly.
Hot tub folliculitis can cause an itchy red rash or pus-filled blisters around your hair follicles. The rash is usually worse in areas where a swimming costume holds water against your skin, such as your buttocks.
Hot tub folliculitis often goes away on its own, but there are topical treatments you can use to help relieve the symptoms. Speak to your doctor if your symptoms get worse, become unmanageable or don’t go away.
Bacterial folliculitis
Bacterial folliculitis is the most common type of folliculitis. It is mainly associated with the bacteria Staphylococcus aureus, which enters the skin and infects the hair follicles. It is often treated with an antibiotic cream or lotion.
Fungal folliculitis
A fungus causes fungal or Pityrosporum folliculitis. It’s usually found in teenagers. It often forms a rash over the shoulders, back, and neck, resembling a cape. If a patient’s acne has worsened or not responded to antibiotic treatment, doctors should consider fungal folliculitis.
Viral folliculitis
Viral folliculitis is usually caused by the herpes virus, which is responsible for cold sores and genital herpes. It often looks the same as bacterial folliculitis but causes painful pustules.
Eosinophilic folliculitis
Eosinophilic folliculitis usually occurs in people with HIV or low white blood cell counts. It causes rashes on the scalp, face, and neck.
What increases your risk of Folliculitis?
Anyone can develop folliculitis, but you are more at risk if you:
- have had it before
- wear tight-fitting clothing
- share personal items such as towels and razors
- avoid showering after exercising
- use hot tubs for prolonged periods of time
- have oily skin
- are stressed
- are diabetic
Bacterial infections like folliculitis are more common and more severe in people with diabetes, especially if uncontrolled. Between 30 and 70% of people with either type 1 or type 2 diabetes will present with some form of skin condition in their lifetime.
Obesity also increases the risk of developing folliculitis, with up to 70% of obese individuals reporting skin changes. Bacterial folliculitis is common, and repeated exposure can result in permanent scarring or dark patches on the skin.
How is folliculitis diagnosed?
A doctor can usually diagnose folliculitis by examining your skin. Your doctor may swab any pustules present to test for infection. If the cause of your folliculitis is thought to be fungal, other tests may be needed. For example, scrapings or hairs from the affected area may need to be sent away for analysis.
You may also require other tests, such as blood and glucose tests, if you have deep folliculitis to rule out any underlying health condition.
How do I know if I have folliculitis?
You will know you have folliculitis if you have symptoms of the condition and a doctor confirms diagnosis. We do not recommend self-diagnosis. If you have any symptoms of folliculitis, you should consult your doctor for advice. They will examine your skin and ask:
- how long you have had your symptoms
- if you have any other symptoms
- if you have had folliculitis in the past
How is Folliculitis treated?
There are treatments available to help relieve the symptoms, and the condition often goes away on its own without treatment. As well as treatments, there are some things you can do to reduce the severity of folliculitis when you have it, like:
- applying a warm compress to the affected area to reduce irritation and discomfort
- avoiding shaving, rubbing or wearing tight-fitting clothing to stop the area from becoming worse
- washing all towels and clothes every day until your symptoms have gone
Hydrocortisone 1% cream is a type of corticosteroid which can be applied to the area to help soothe the itching, swelling, or redness. You should only use Hydrocortisone cream for as long as your doctor tells you to because it can cause side effects, and can occasionally cause folliculitis in its own right.
How to treat Folliculitis
Folliculitis often goes away on its own, but if it takes a long time to heal or your symptoms are severe, you may need medication. For mild cases of folliculitis, you may be able to manage it with the following:
- over the counter non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
- antihistamines to help relieve the itching
The treatments prescribed by your doctor will depend on the cause of folliculitis.
- Bacterial folliculitis may need to be treated with topical and or oral antibiotics to get rid of the infection.
- Fungal folliculitis will need to be treated with antifungal medicines. The most common examples are itraconazole and fluconazole.
- Viral folliculitis may be treated with oral aciclovir, valaciclovir, or famciclovir if it is secondary to the herpes simplex virus.
How to treat Folliculitis naturally
There are several things you can do to treat folliculitis yourself, including:
- clean the affected skin twice a day with warm soapy water and pat dry with a towel (remember not to share this with anyone else)
- apply a warm, moist compress to the affected area to help relieve the irritation
- wear loose-fitting clothes
- avoid shaving the area
- avoid waxing as this can increase the risk of folliculitis
- some essential oils may help to treat folliculitis, look out for moisturisers or cleansers that contain tea tree oil, chamomile oil, eucalyptus oil
How to prevent Folliculitis
There are things you can do to help prevent folliculitis, such as:
- shaving in the direction hair grows rather than against it
- using cleansing products and moisturisers that do not clog your pores
- avoiding sharing towels and razors
- avoiding wearing tight-fitting fabrics
- showering after exercising or heavy sweating
What skin conditions are similar to Folliculitis?
Folliculitis shares some symptoms with other skin conditions, which means they can be mistaken for each other. This is why it’s always important to get a proper diagnosis from a doctor to make sure.
Herpes or folliculitis
Herpes simplex and folliculitis can look similar, and it is important to distinguish between the two because herpes can be spread from person to person. Some of the key differences include:
- herpes lesions usually appear after sexual contact where folliculitis is caused by friction, for example, shaving, wearing tight clothing, and cycling
- folliculitis usually covers a larger local area, usually on a hairy part of the body. Herpes is usually clustered together in a smaller area
- folliculitis is not usually painful, whereas herpes can be quite sore
- folliculitis does not cause discharge to occur from the penis or vagina
Hot tub folliculitis or chickenpox
Hot tub folliculitis can look like chickenpox. Chickenpox usually happens in three stages, and new spots can appear as others are blistering over. Chickenpox can also appear inside the mouth and around the genitals. Chickenpox can also cause other symptoms that hot tub folliculitis usually doesn’t, such as:
- a high temperature
- loss of appetite
- generally feeling unwell
- aches and pains
Acne vs folliculitis
Folliculitis can look similar to acne, but they need to be treated in different ways. They also have different causes because blocked pores cause acne, while inflamed hair follicles cause folliculitis. If you have red bumps that aren’t going away, you should consult your doctor to get a diagnosis.
Hot tub folliculitis or bed bugs
Hot tub folliculitis can look like bed bug bites, but there may be some differences.
- hot tub folliculitis rashes are usually widespread and found in areas which bed bugs may not be able to reach
- bed bugs usually bite areas that are accessible such as arms and leg
- a history of having been in a hot tub recently would point towards folliculitis
Sources
- Cutaneous Manifestations of Diabetes Mellitus (2015) NIH [accessed 02 November 2022]
- Folliculitis (2022) NIH [accessed 02 November 2022]
- Hot Tub Folliculitis (2022) Spa Marvel [accessed 02 November 2022]
- Obesity and Dermatology (2004) NIH [accessed 02 November 2022]
- Obesity and Skin (2022) NIH [accessed 02 November 2022]
- Skin Manifestations of Diabetes Mellitus (2022) NIH [accessed 02 November 2022]