Folliculitis Facts

The characteristic finding in folliculitis is redness, swelling, and often pustule formation limited to hair follicles by iStock
  • Folliculitis is an inflammation of the hair follicle, a structure composed of cells designed to produce hair.
  • Causes of folliculitis include bacteria, fungi parasites, chemicals, and drugs.
  • Redness, swelling, and pustule formation centered around the hair follicle opening commonly occur with folliculitis.
  • Sometimes folliculitis is due to an auto-inflammatory process and not produced by external toxic factors (acne is an example).
  • Serious folliculitis requires a visit to the doctor.
  • Management of folliculitis requires investigation of the cause. Most folliculitis responds well to treatment.
  • Most folliculitis is not contagious, however, folliculitis causes by infectious agents may be transmitted through skin contact, shared razors, or hot tubs.

What Causes Folliculitis?

There are two basic categories of cause of folliculitis, infections and all other causes of hair follicle inflammation.

  • Infections by bacteria (Staphylococcus aureus for example), fungi (yeasts and dermatophytes), viruses (herpes simplex), and parasites (Demodex mites) can cause folliculitis.
  • Noninfectious causes of folliculitis include topical irritants (insoluble cutting oils are an example), physical irritants (hair extraction), certain drugs, teenage pimples (acne vulgaris), and certain auto-inflammatory conditions (folliculitis decalvans).

What Are Folliculitis Risk Factors?

Folliculitis does not occur on the palms or soles or on mucous membranes, since they have no hair follicles.

  • Exposure to potential infectious agents and certain types of occupational exposures can predispose to folliculitis.
  • Football players and wrestlers are predisposed to develop staphylococcal folliculitis due to the presence of superficial skin abrasions related to their athletic participation.
  • There is a well-known condition called "hot tub folliculitis" which can affect those who frequent poorly maintained hot tubs. These people develop a folliculitis produced by Pseudomonas bacteria.
  • Poor shaving techniques can produce folliculitis on the legs of women and the necks of men.
  • Pregnant women are prone to develop an itchy folliculitis that resolves spontaneously after delivery.
  • Patients with HIV disease may develop a peculiar folliculitis produced by certain white blood cells (eosinophils) infiltrating into the follicles as well as a widespread folliculitis produced by molluscum contagiosum virus.
  • A group of new anticancer drugs, epidermal growth factor receptor inhibitors, can produce a facial folliculitis.

What Are Symptoms and Signs of Folliculitis?

The characteristic finding in folliculitis is

  • redness,
  • swelling, and
  • often pustule formation limited to hair follicles.

It may be possible to identify a hair surrounded by red, swollen tissue.

  • Occasionally this may be associated with itching and mild pain or tenderness.

When Should Someone Seek Medical Care for Folliculitis?

Virtually all human beings experience folliculitis at some time in their lives with the vast majority of cases spontaneously resolving. So medical care should be sought only if the condition persists and starts to hinder normal daily activities.

  • Bacterial folliculitis can produce deeper abscesses commonly called boils which often require a draining procedure and/or oral antibiotics.
  • If caused by an antibiotic-resistant bacteria (MRSA, or methicillin-resistant S. aureus), the doctor may have to culture the pus to determine the correct drug to prescribe.

How Do Doctors Assess and Diagnose Folliculitis?

Since there are so many causes of folliculitis, precision in diagnosis is often difficult. If it becomes necessary to see a physician, it is often essential to culture for microorganisms and occasionally to perform a biopsy of the follicular tissue for pathologic examination.

  • For noninfectious causes, it is critical to obtain a history that accurately implicates exposure to an inciting agent.
  • Certain auto-inflammatory conditions may have a characteristic clinical appearance that the physician can recognize.

What Are Treatment Options for Folliculitis?

Treatment depends on the diagnosis. It is very important not to miss a diagnosis caused by an infectious organism because these infections can often be cured by the appropriate medication.

  • Folliculitis produced by poor shaving technique can be treated with weak topical steroids like 1% hydrocortisone cream.
  • Bacterial folliculitis can be treated with antibacterial skin washes and topical antibiotics
  • Fungal folliculitis can be treated with an antifungal shampoo or body wash.
  • Persistent skin discoloration can be treated with prescription fading creams like hydroquinone 4%.

Are There Folliculitis Home Remedies?

It is important to avoid manipulating an area of folliculitis because this can produce additional tissue damage, change the appearance of the eruption to make it unrecognizable to the doctor, and force microorganisms more deeply into the skin.

Are There Ways to Prevent Folliculitis?

One should wash the skin with soap and water soon after participating in any activity that might result in exposure to pathogenic microorganisms. Reducing exposure whenever possible to exogenous agents like drugs or topical substances that might be implicated would be prudent.

What Is the Prognosis for Folliculitis?

Most patients recover from folliculitis completely. There can be occasional recurrences.

Causes of Folliculitis

Staphylococcus aureus (S. aureus)

Almost any organ system can be infected by S. aureus. Most frequently, S. aureus strains first infect the skin and its structures (for example, sebaceous glands, hair follicles) or invade damaged skin (cuts, abrasions). Sometimes the infections are relatively limited (such as a sty, boil, furuncle, or carbuncle), but other times they may spread to other skin areas (causing cellulitis, folliculitis, or impetigo).

Durdu, Murat, and Macit Ilkit. "First Step in the Differential Diagnosis of Folliculitis: Cytology." Critical Reviews in Microbiology 39.1 (2013): 9-25.

Luelmo-Aguilar, Jesús, and Sàbat Santandreu, Mireia. "Folliculitis: Recognition and Management." Am J. Clin Dermatol 5.5 (2004): 301-310.