What is Folliculitis ?

It is a condition caused due to infection of the hair follicles by Staphylococcus aureus or other bacteria. Some variants of folliculitis are also called barber’s itch or hot tub folliculitis. Extreme cases can result in scarring and permanent loss of hair. Mild cases of folliculitis can cause embarrassment and discomfort

The infection normally occurs as tiny pimples with white heads around hair follicles. A majority of cases are shallow and itchy, but occasionally can be painful. Shallow folliculitis tends to clear on its own within a few days, but recurrent and deep folliculitis may need medical care.

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Symptoms of folliculitis

Some of the signs and symptoms of folliculitis are as follows:

  • Scalp folliculitis affects the scalp hair follicles. It is also known as ‘Proprionibacterium folliculitis’ or ‘acne necrotica miliaris.’ It causes tiny, intensely itchy pustules within the scalp, primarily affecting the frontal hairline. The lesions may occur in small numbers or may be appear as many lesions. They tend to become sore and crust over.
  • Superficial or shallow folliculitis which affects the top layer of the hair follicles can cause:
    • Groups of tiny, pus filled or reddish lumps that forms around hair follicles
    • Inflamed and reddened skin
    • Pus filled blisters that rupture and experience crusting
    • Tenderness or itchiness
    • Deep folliculitis affects the complete hair follicle and begins deeper in the surrounding skin, causing:
      • A big swollen lump or growth
      • Pain
      • Pus filled blisters that rupture and crust over
      • Possible scarring after clearance of infection

Types of folliculitis

The superficial types of folliculitis are listed below:

  • Staphylococcal folliculitis: It results in whitish, itchy, pus-filled lumps that can affect any area of the body containing hair follicles. When the condition occurs in a man’s beard region, then it is known as barber’s itch. It is caused due to infection of the hair follicle by staph bacteria. It may be noted that staph bacteria are normally present in all individuals, but usually lead to health problems when they enter the body via a wound or a cut. This can happen while shaving, scratching or skin trauma or injury.
  • Pseudofolliculitis barbae: It refers to inflammation of the beard area hair follicles, and affects men due to the curving back of saved hairs into the skin. It causes inflammation and occasionally results in dark, elevated scars on the neck and face.
  • Hot tub folliculitis: Also called pseudomonas folliculitis, it is caused due to infection by the pseudomonas bacteria which can flourish in different environments, which include hot tubs with unregulated levels of pH and chlorine. A rash comprising of circular, reddish, itchy bumps develops within 8 hours to 5 days post exposure to the bacteria, which may later form into tiny, pus-filled blisters.
  • Pityrosporum folliculitis: It is caused due to yeast infection and results in reddish, itchy and persistent pustules on the chest and back and occasionally on the shoulders, neck, face and upper arms. It is more common in adult men and teenagers

The deep types of folliculitis are listed below:

  • Sycosis barbae: It affects men who have started shaving and features inflammation of the entire hair follicle area. Initially, tiny pustules occur on the chin, upper lip, and jaw and later become more prominent due to continued shaving. Severe cases may lead to scarring.
  • Boils and carbuncles: Deep infection of the hair follicles by staph bacteria results in sudden appearance of a pinkish or reddish, painful lump. There may also be redness and swelling of the surrounding skin. The lump later fills with pus and becomes more painful and bigger, before finally bursting and draining. Tiny boils normally heal without scaring, while large boils can cause scarring. A carbuncle refers to a cluster of boils affecting the shoulders, back of neck or back of thighs. It leads to a more severe and deeper infection as compared to single boils and hence experience slower formation and healing.
  • Gram-negative folliculitis: It may result from prolonged antibiotic treatment which can affect the normal balance of bacteria living in the nose leading to excess growth of harmful pathogens, i.e. gram-negative bacteria. Stopping antibiotic therapy resolves the problem in most patients. However, in some affected people, it can result in new, intense acne lesions
  • Eosinophilic folliculitis: It most affects HIV infected patients and causes recurrent blotches of pus-filled, inflamed sores on the face, upper arms or back. The condition tends to be extremely itchy, spreads and causes dark pigmentation of the affected skin.

Causes of folliculitis

  • Folliculitis is caused due to hair follicle infection by bacteria, fungi or viruses, with the primary cause being staph infection. The condition is densest on the scalp but can affect all parts of the body, with the exceptions being the mucus membranes, soles and palms.
  • Damage of the hair follicles due to shaving, perspiration, skin injuries inflammatory skin disorders, tight clothing, etc. can increase the susceptibility to developing folliculitis.

Treatment of folliculitis

  • Staphylococcal folliculitis is treated with oral or topical antibiotics. Avoid shaving or shave with an electric razor or a new blade, till the infection heals
  • Pseudofolliculitis barbae is treated by engaging in proper self-care and proper shaving procedures, use of shaving gels, moisturizers, etc.
  • Pseudomonas folliculitis: The condition is treated as per individual cases, along with topical or oral medicines to alleviate itching. Severe cases may need oral antibiotic therapy
  • Pityrosporum folliculitis is treated with oral and topical anti-fungal medications. Recurrent cases may require indefinite use of topical antifungal drugs.
  • Gram-negative folliculitis may be caused due to prolonged use of antibiotics to cure acne, but this type of folliculitis is treated with topical or oral antibiotics
  • Sycosis barbae: A topical antibiotic along with warm saline compresses may be suggested. Serious cases may require oral antibiotics
  • Eosinophilic folliculitis: It is usually treated with topical corticosteroids, with severe cases requiring a short dosage of oral corticosteroids. HIV/AIDS patients with mild eosinophilic folliculitis may be treated with oral antihistamines along with topical steroids.
  • Doctors may treat boils and carbuncles by draining the skin abnormalities via an incision. Recurrent and severe cases may need treatment with antibiotics.

Folliculitis Pictures

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