Folliculitis is a common, benign skin problem that causes an eruption of bumps or pimples surrounding by inflamed skin. ‘Razor bumps,’ ‘shaving rash,’ ‘barber’s itch,’ and ‘hot tub rash’ are other common names for folliculitis.
The condition often affects the face, neck, armpits, thighs, buttocks, groin, back or chest. In fact, it can affect skin on any part of the body, except skin that does not have hair such as the lips, eyelids, palms of the hand, and soles of the feet. It usually clears up on its own in a few days without treatment.
Folliculitis is not a serious or life-threatening condition. If the condition persists, you may need to seek medical attention. Diagnosis is done by a doctor using visual examination or a technique known as dermoscopy to take a closer look at the skin under a microscope.
There are several reasons why folliculitis occurs. The following are the most common causes of folliculitis:
Bacteria: The bacteria Staphylococcus aureus or “Staph” is one of the most common causes of folliculitis. Staph is normally present on the skin without causing trouble unless it gets into the body through an opening, such as a cut, and infects the hair follicles. Other types of bacteria, for example, Pseudomonas bacteria, found in contaminated water in a hot tub, swimming pool or lake may also enter the body and cause bacterial folliculitis.
Blocked Follicles: Using oily skin products can block the hair follicles. Dead skin cells and injury to the skin due to friction from tight clothing can also block the hair follicles. Once this happens, the pores become inflamed and cause a cluster of red bumps to appear. When the hair follicles are severely infected, a large, painful boil or cluster of boils (carbuncle) may appear.
Yeast and Fungus: A yeast called pityrosporum can also cause folliculitis. Pityrosporum is normally found on the skin and is harmless unless it overgrows and gets into the hair follicles causing a fungal skin infection. The trunk of the body, the face, shoulders, and upper arms are mainly affected by this type of folliculitis.
Ingrown Hair: Shaving can result in folliculitis due to ingrown hair. This type of folliculitis is called ‘razor bumps’ or ‘barber’s itch.’ The bumps occur after shaving too closely. They appear inflamed and noticeable mostly on the face and neck of men. Barber’s itch may appear in the groin too, especially in women who get a bikini wax.
Disease: A type of folliculitis known as eosinophilic folliculitis may affect people whose immune system is compromised, such as those with HIV/AIDS, chronic leukemia or cancer. Recurrent itchy bumps and pimples usually appear near the hair follicles of the trunk and face. The skin typically becomes darker or hyperpigmented once the condition heals.
Medication: Some people who take medications, such as corticosteroids for treating inflammation or antibiotics for long-term treatment of acne have developed folliculitis or gram-negative folliculitis.
Anyone at any age can develop folliculitis. It usually appears as numerous pinpoint red bumps that look like lesions on the surface of the skin. Each bump represents an infected or inflamed hair follicle. The condition should be diagnosed by a doctor since there are other skin conditions that may look similar and may require different treatment. You may have developed folliculitis if you notice the following signs or symptoms on your skin:
• A cluster of tiny red bumps that look like pimples and feel sore
• Pimples with a white head
• Large swollen bumps or group of bumps
• Blisters filled with oozing pus
• Burning and itching of the skin (inflamed)
• Skin is tender and painful to touch
• Bumps crust over and leave scarring when healed
This common skin condition is curable, even though it usually clears up on its own within a few days. Various self-care methods can help to ease the discomfort and symptoms. These include washing the affected area with antibacterial soap or warm salt water. Over-the-counter antibiotic or itch cream such as hydrocortisone can bring relief.
In some cases, your doctor may need to treat you. Some forms of treatment that may help get rid of folliculitis are as follows:
• Creams—antibiotic cream, gel or lotion for bacterial folliculitis
• Pills—oral antibiotic pills for severe cases caused by bacteria
• Antifungal creams and shampoos—prescribed when the condition is caused by yeast
• Steroid cream—to reduce swelling and itching, especially in people with a weakened immune system (HIV/AIDS, leukemia, cancer)
• Surgery—large, pus-filled boils may be drained using minor incision surgery
• Laser hair removal—to permanently remove infected or inflamed hair follicles
Sometimes treatment does not clear up the infection. Your doctor may take and send a sample of the infected hair or skin to a lab to determine the cause of the infection. Other tests, such as a skin biopsy, may be done to determine if folliculitis is caused by a pre-existing condition.
• Furunculosis (boils under the skin)
• Infected bumps may turn into abscess or cyst
• May recur (due to pre-existing health conditions) or spread
• Permanent hair loss
• Skin damage, e.g. scarring
• Hyperpigmentation (dark discoloration of the skin)
Folliculitis is not contagious, but it can spread on contact with someone who has bacterial folliculitis or by using infected personal care items such as razors or towels. The following preventative measures can be taken to stop the condition from occurring or recurring:
• Avoid wearing tight clothing, especially those that cause friction with the skin or trap heat and sweat, e.g. Lycra.
• Avoid sharing shaving razors, bath towels or other personal care items that trap bacteria.
• Avoid shaving or clean, close shaves. Clean shaving is a primary cause for folliculitis in men.
• Shave less frequently and adopt an after-care regimen to protect the skin (such as cleaning the skin with antibacterial soap and applying aftershave lotion or moisturizer).
• Try other methods of hair removal, such as hair removal creams.
• Use only hot tubs and swimming pools you know are well-maintained and not contaminated.
• Limit the use of oily skin products.
• Wash off tar and mechanical grease from the skin thoroughly with warm soapy water.