What is Folliculitis?

Folliculitis is an inflammation of the hair follicles, the tiny tunnels in the skin from which hair grows. It occurs when the hair follicles become irritated and an infection then sets in. This may be seen with damage to the follicle as a result of shaving, friction with clothing, scratching, or an obstruction of a pore. An infected hair follicle appears as a red bump or white pustule which may crust over at a later stage (Picture 1). Infectious folliculitis which arises with a Staphylococcus aureus (bacteria) infection is discussed in detail within this article. Read about other types of folliculitis.

Folliculitis Pictures

Pictures in this article show staphylococcal folliculitis. Links to pictures of other types of folliculitis.

Staph Folliculitis

Picture 1: Staphylococcal folliculitis with red bumps and pus-filled white centers.
(source: Samuel Freire da Silva, M.D., Atlasdermatologico)

Folliculitis on the Chest

Picture 2: Staphylococcal folliculitis on the woman’s chest
Click to enlarge >> © Dermnet

Folliculitis on Thighs

Picture 3:Staphylococcal folliculitis on thighs
Click to enlarge >> © Dermnet

Folliculitis Pictures on the Web

Folliculitis Pictures on Dermnet
Folliculitis Pictures on Dermnetnz
Folliculitis Pictures on Visualdxhealth

Folliculitis and Acne

Folliculitis and acne are two different skin conditions although gram-negative folliculitis may be seen in certain cases of severe acne. Acne primarily involves the oil-producing glands (sebaceous glands) of the skin which are clogged with excess oil (sebum) and shed skin cells. It may lead to localized inflammatio which may then develop into folliculitis (Picture 5). Due to the similarity of the lesions, it may sometimes difficult to differentiate between acne and folliculitis only by visual examination. Some key points to bear in mind though is that acne occurs mainly on the face, neck and upper trunk, more often in teenagers, and may last for months or years. Folliculitis on the other hand may occur anywhere on the body, can affect at any age group, and it usually lasts only for a few days or weeks.

Folliculitis-Infected_Acne

Picture 5:Infected acne plus non-infected comedones
Click to enlarge >> © Dermnet

Symptoms of Staphylococcal Folliculitis

Staphylococcal folliculitis usually appears as clusters of red bumps surrounding hair follicles (with or without the hair). It varies between 2 to 5 millimeters in diameter, often with a white blister in the center (Pictures 1-3). Inflamed follicles may burst, release pus and crust over. The skin in superficial folliculitis is itchy and tender while in  deep folliculitis it may be painful.

Folliculitis most commonly occurs on the :

  • Beard area in men
  • Scalp
  • Upper trunk (chest, under breasts, in armpits)
  • Buttocks
  • Thighs
  • Groin

Folliculitis never appears in areas without hair follicles such as the palms, soles, or mucous membranes. Superficial folliculitis affects only upper parts of a hair follicle, while deep folliculitis affects the whole hair follicle.

Folliculitis Barbae

Folliculitis barbae is a superficial folliculitis of the bearded area in men, caused by Staphylococcus aureus (staph) bacteria. It often appears on the skin around the nose or mouth when hair follicles that are damaged during shaving become infected, especially in those who are nasal staph carriers.

Folliculitis_Barbae_Beard

Picture 6:Folliculitis barbae
(source: Samuel Freire da Silva, M.D., Atlasdermatologico)

Pseudofolliculitis Barbae (Ingrown Hair)

An ingrown hair is a curly hair that curves or twists on the surface and then re-enters the hair follicle opening again. This causes inflammation of the follicle (folliculitis). It may resemble bacterial folliculitis but pseudofolliculitis barbae this is not an infection and tends to occur in those who shave with a razor blade. The use of an electric razor may be one of the preventative measures that may be employed, along with shaving every second day or resorting to not shaving and letting the beard grow (3).

Pictures of Pseudofolliculitis Barbae (Shaving Bumps)

Sycosis Barbae

Sycosis barbae is deep folliculitis of the bearded area in men and involves the deeper parts of hair follicles. Sycosis barbae may leave scars.

Picture of Sycosis Barbae

Stye

A stye is an inflammation or infection of a hair follicle on the eyelid.

Folliculitis, Stye

Picture 7:Stye (staphylococcal folliculitis) on the lower eyelid
Click to enlarge >> © Dermnet

Risk Factors for Folliculitis

Folliculitis is more likely to occur in:

  • Nasal staph carriers
  • Diabetes mellitus
  • Dermatitis
  • Obesity
  • Topical steroid treatment
  • Lowered immunity (leukemia, AIDS)
  • Acne treatment with tetracycline
  • Infants with tight clothes
  • Athletes
  • Hot humid climates

Folliculitis Diagnosis

Folliculitis may be diagnosed by a medical doctor without any further tests. However, if there is doubt about the diagnosis, then swabs or biopsies of the skin lesions are collected and sent for laboratory testing.  In recurrent folliculitis, diabetes and HIV tests should be considered.

Compare Pictures of Folliculitis with Other Types of Rash

Folliculitis Treatment

  • Superficial folliculitis may heal on its own within 1 to 2 weeks.
  • Applying over the counter (OTC) antibiotic ointments like Bacitracin, Mycitracin (bacitracin + neomycin + polymyxin B), or Bactrobam (mupirocin), or washing with antibacterial soaps may help in more resistant cases (2).
  • In a deep folliculitis and recurrent cases, oral antibiotics (dicloxacillin, cephalosporins) may be needed.
  • Folliculitis caused by MRSA requires treatment by antibiotics chosen on the basis of antibiotic sensitivity test (1).

During acute stages, electric razors should be used or shaving should be temporarily avoided in this time. S. aureus carriers may be treated with mupirocin ointment in the nasal vestibule twice a day for 5 days (1). Family members may be also treated by mupirocin to eliminate the carrier state and prevent re-infection.

Is Folliculitis Contagious?

Staphylococcal folliculitis is very contagious. It spreads by direct skin-to-skin contact, or by sharing razors, towels, clothes or other personal items.

Prevention of Folliculitis

The following measures may help to prevent folliculitis :

  • Wear comfortable airy clothes.
  • Wash and dry swimming suits and sport apparel after each use.
  • Eradicate nasal staphylococci.
  • Laser depilation for hair removal.
  • Disinfect of a sport equipment and hot tubs.
  • Do not share razors and towels.
  • Apply a disinfectant on any break in the skin with shaving.

Folliculitis Complications

Folliculitis may result in :

  • Furuncles
  • Cellulitis – inflammation of deeper layers of the skin
  • Scars or hyper-pigmentation
  • Permanent hair loss (alopecia)

Pictures of Other Types of Folliculitis

Several other types of folliculitis beside staphylococcal folliculitis are known:

Related Articles:

References:

  1. Antibiotics for staphylococcal folliculitis (emedicine.com)
  2. Antibiotic ointments for folliculitis (bestincosmetics.com)
  3. Ingrown hair – shaving bumps (aocd.org)

Article reviewed by Dr. Greg. Last updated on August 3, 2013