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Folliculitis

Folliculitis is a condition where your hair follicles become inflamed, causing pus-filled swellings (pustules) and painful red bumps to develop on your skin.

About folliculitis

A hair follicle is a pouch in your skin from which hair grows. If it becomes inflamed, the condition is known as folliculitis.

Illustration showing the hair follicle in the skin

Folliculitis is common and can affect people at any age, although adults are more likely to get it than children.

Symptoms of folliculitis

Symptoms of folliculitis can include having:

  • pus-filled swellings (pustules)
  • red, itchy and/or painful skin
  • red swellings (papules)

If a hair pierces through one of the swellings, a crust may form over it.

Folliculitis can develop in any area where hair grows, but usually occurs on your scalp, legs, armpits, buttocks or on your face. Often, many follicles are affected.

If you have these symptoms, see your GP.

Complications of folliculitis

Folliculitis usually affects the upper layer of the hair follicle, near the surface of your skin. If the infection spreads deeper, it can cause boils or a more widespread skin infection called cellulitis.

Persistent and severe folliculitis can cause scarring and, if the hair follicle is damaged, permanent hair loss, but this is rare.

Causes of folliculitis

Common causes of folliculitis are listed below.

  • Bacterial infection. Staphylococcus aureus and Pseudomonas aeruginosa bacteria are the most common cause of folliculitis. P. aeruginosa thrives in pools, whirlpools or spas that don't have enough chlorine.
  • Ingrowing hairs. If you shave or wax, ingrowing hairs can develop and cause inflammation. This is known as pseudofolliculitis.
  • Excessive sweating and wearing tight clothing. These factors can make you more likely to have folliculitis.

Less common causes of folliculitis are listed below.

  • Fungal infection. Yeasts such as Dermatophytes, Malassezia and Candida species can infect your hair follicles and cause inflammation.
  • Viral infection. Herpes simplex, varicella-zoster and molluscum contagiosum viruses can cause folliculitis.
  • Mite infection. Parasites (such as Demodex folliculorum) that live in hair follicles and sweat glands can cause folliculitis.
  • A poor immune system. People who have a weakened immune system, such as those who have HIV/AIDS, or who are taking medicines that suppress their immune system, are more likely to develop folliculitis.

Diagnosis of folliculitis

If you think you have folliculitis and it causes you discomfort or doesn't clear within a few days, you should see your GP. He or she will ask about your symptoms, examine you and may also ask you about your medical history. Your GP will usually be able to diagnose folliculitis by examining your skin.

If the folliculitis doesn’t respond to treatment or keeps coming back, your GP may take a swab from the affected area. This will be sent to a laboratory for testing to find out the cause of the infection.

Treatment of folliculitis

Folliculitis usually clears up quickly and gets better on its own within two to 10 days. However, depending on how severe it is, your GP may recommend medicines to help clear up any infection.

Self-help

There are things you can do on your own to help clear up folliculitis.

  • Don’t shave or wax the affected area until the folliculitis has cleared.
  • Wash the affected area every day with an antiseptic product, such as chlorhexidine or triclosan. You can purchase these over the counter from a pharmacy. They can come as lotions, creams, soap substitutes or a solution that you add to a bath. For more information, ask your pharmacist for advice.
  • Maintain good hygiene. Take a bath or shower daily, and change your clothes, bedding and towels regularly.
  • Don’t scratch the affected area. If you touch a pustule, wash your hands thoroughly using hot water and soap. This will help to prevent you spreading any germs to other parts of your body.
  • Wear loose clothing to avoid friction and help keep your skin cool.

Medicines

There is a range of medicines that can help treat folliculitis. The type of medicine you have will depend on your general health, the cause of the folliculitis and how widespread it is. Your GP will recommend a treatment that is most suitable for you. It's important that you finish your course of treatment. Always ask your GP for advice and read the patient information leaflet that comes with your medicine. If your folliculitis doesn't clear up after you have completed your treatment or if your condition worsens, contact your GP.

Antibiotics
Folliculitis is often caused by bacteria. If the infection is mild, your GP may recommend washing the affected area every day with an antiseptic product. Alternatively, he or she may prescribe an antibiotic cream, such as fusidic acid or mupirocin, to treat the infection. If the folliculitis is severe or keeps coming back, your GP may prescribe antibiotic tablets, such as flucloxacillin or erythromycin.

Antifungal therapy
If your folliculitis is caused by a yeast infection, your GP may prescribe ketoconazole shampoo and/or cream to treat the infection, or tablets such as fluconazole or itraconazole.

Antiviral therapy
If your folliculitis is caused by a viral infection, your GP may prescribe aciclovir, valaciclovir or famciclovir. A five to 10-day course of antiviral therapy is usually recommended.

Mite treatment
If your folliculitis is caused by mites, your GP may prescribe permethrin cream or malathion lotion to treat it.

Prevention of folliculitis

Folliculitis is usually caused by bacteria entering your hair follicles and causing inflammation. There are things you can do to reduce your risk of getting folliculitis. Some examples include the following.

  • Maintain a good hygiene routine.
  • Wear loose clothing and change your bedding and towels frequently.
  • Wash daily with antibacterial soap.
  • When shaving, take care not to nick or cut your skin.
  • Clean your razor with boiling water or antiseptic solution after each use.
  • Use an antiseptic lotion instead of your usual shaving soap or foam.
  • Don’t share your razors with others.

Women who have recurrent folliculitis may want to consider having laser hair removal or use a depilatory.

 

Produced by Krysta Munford, Bupa Health Information Team, August 2012.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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