Folliculitis

Folliculitis is inflammation of the hair follicles in your skin.

There are 2 types of folliculitis:

1. non-infective folliculitis
2. infective folliculitis

Folliculitis causes painful red bumps each with a hair in the middle.

If you have folliculitis, the bumps may also:

• become itchy
• be sore or tender
• contain pus

It can happen on any part of your body where there's hair.

Folliculitis can affect just the surface of your hair follicle. It can sometimes affect the whole hair follicle. This can cause bumps under your skin.

With a severe infection, you may feel unwell or have a fever (a temperature of 38°C or higher). This is rare.

Folliculitis often appears on parts of your body that are sweaty, or around the beard area in males. It's more likely to happen if you wear tight clothing.

Folliculitis can be caused by different things.

Causes of non-infective folliculitis

Non-infective folliculitis is caused by:

• shaving and waxing
• obesity
• wet skin such as from heavy sweating
• use of oils on the skin
• certain types of medicines

Shaving and waxing can change the direction your hair grows — wearing tight clothes can make this worse. This can cause irritation and folliculitis.

If you shave your face you may get a chronic (ongoing) inflammation in your beard area. As the hair grows, the cut end digs into the skin causing inflammation. This is called pseudofolliculitis barbae. It most often affects men with darker skin and tightly curled hair.

Using oils, creams and ointments that block the hair follicle can also cause folliculitis. This includes some medicines that are used on the skin, such as corticosteroids.

Other medicines can also cause folliculitis, especially in people who have acne. These medicines might include:

• oral corticosteroids
• hormone therapy
• anticonvulsants
• some cancer treatments
• some medicines for mental health

Eosinophilic folliculitis mostly affects the head and neck. It's not known what causes this type of folliculitis. In some cases, it may be caused by your immune system not working properly.

Causes of infective folliculitis

Infective folliculitis can be caused by:

• bacteria
• viruses
• fungi

The most common bacteria that cause folliculitis are:

• staphylococcus aureus (bacterial folliculitis) — commonly found on your skin
• pseudomonas aeruginosa (hot tub folliculitis) — found in hot tubs and spas
• klebsiella, enterobacter and proteus bacteria (gram negative folliculitis)

Folliculitis decalvans is a rare type of folliculitis that can cause hair loss. It's thought to be due to an abnormal immune system response to staphylococcus aureus infection. It can be passed down in some families.

Other causes of infective folliculitis are:

• demodex mites
• malassezia yeasts (pityrosporum folliculitis)
• herpes simplex virus

Some medicines can increase your chance of getting folliculitis, such as immunosuppressants (medicines that suppress your immune system). Long-term use of antibiotics can cause gram negative bacterial folliculitis.

Folliculitis is not contagious, unless it's caused by bacteria. For example, staphylococcus aureus can be spread through skin-to-skin contact.

Sweating, shaving and waxing can increase your chance of getting infective folliculitis.

Some medical conditions, such as diabetes, can also increase your chance of infective folliculitis.

If you think you might have folliculitis, see a doctor. They can diagnose your condition, give you advice and suggest treatment.

Your doctor will take your medical history and examine you. If they suspect that you have infective folliculitis, they will take a swab for testing.

You may need a skin biopsy to diagnose the cause of your folliculitis. This is more likely if you have other symptoms like hair loss.

If needed, your doctor can also refer you to a dermatologist (skin specialist).

Treatment of folliculitis depends on its cause.

There are some general measures you can try.

• Keep your skin cool and avoid sweating.
• Avoid friction and constriction from tight clothes — try loose cotton clothing.
• Choose oil-free skin products.
• Rub ointments into your skin in the direction your hair is growing.

Treatment for non-infective folliculitis

If you have non-infective folliculitis, your doctor may suggest that you:

• try a warm compress
• wash the area with an antiseptic
• make sure you use a sharp razor when shaving

Most cases of folliculitis will get better with time and the above measures.

If you have folliculitis from shaving, try:

• taking a break from shaving — this can help your folliculitis to get better
• using plenty of shaving gel (not soap)
• shave in the same direction that your hair is growing
• don't pull or stretch your skin while shaving

Treatment for infective folliculitis

If you have infective folliculitis your treatment will depend on the cause of the condition.

Infective folliculitis might need to be treated with antibiotics.

Some cases of folliculitis can be deeper in the skin and cause boils. Large boils might need treatment to help the pus drain.

Severe cases of folliculitis may cause scarring and rarely, bald patches.

You can help prevent folliculitis by:

• keeping your skin clean and dry — wear breathable clothing and change out of wet or sweaty clothes quickly
• avoiding things that irritate your skin
• choosing skin products that don't clog your pores

You can read about folliculitis (Opens in new tab) on The Australasian College of Dermatologists (Opens in new tab) website.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.