Folliculitis

According to the Mayo Clinic, folliculitis is a common skin condition.  It occurs when hair follicles become inflamed. It is usually caused by a bacterial or fungal infection. First, tiny small red bumps or white-headed pimples may be visible around where the hair follicle protrudes the skin.   Each protruding infected hair follicle can turn into nonhealing, crusty sores.[i]

Sometimes the skin is “too thick” for new hair to break through the skin. When this happens, it is commonly referred to as an “ingrown hair”.  Ingrown hair (aka “folliculitis”, once it is infected) can often happen after shaving or waxing. 

Folliculitis is not life-threatening, but it can be itchy, sore and embarrassing. On first glance to an untrained eye, it could even look like a STD.  Severe folliculitis/infection can cause permanent hair loss and scarring.

Folliculitis signs and symptoms include:

• Clusters of small red bumps or white-headed pimples that develop around hair follicles and can develop into a large swollen bump or mass
• Pus-filled blisters that break open and crust over
• Itchy, burning, painful and/or tender skin

The 2 Main Types of Folliculitis: Superficial & Deep

According to Mayo Clinic, the superficial type involves “part” of the hair follicle, and the deep type involves the “entire” hair follicle and is usually more severe.

Forms of Superficial Folliculitis Examples Include:

Bacterial Folliculitis

This common type of folliculitis is marked by itchy, white, pus-filled bumps. It occurs when hair follicles become infected with bacteria, usually Staphylococcus aureus (staph). Staph bacteria live on the skin all the time, but they generally cause problems only when they enter the body through a cut or other wound.

Superficial Folliculitis (continued)

Hot Tub Folliculitis/Pseudomonas Folliculitis

With this type you may develop a rash of red, round, itchy bumps one to two days after exposure to the bacteria that causes it. Hot tub folliculitis is caused by pseudomonas bacteria, which is found in many places, including hot tubs and heated pools in which the chlorine and pH levels aren't well-regulated. 

Pityrosporum Folliculitis

This type produces chronic, red, itchy pustules on the back and chest and sometimes on the neck, shoulders, upper arms and face. This type is caused by a yeast infection.

In this photo of pityrosporum folliculitis below, a 25-year-old man presents with complaints of slightly pruritic (itchy), monomorphic follicular papules, pustules, and secondary keloid on the upper trunk and neck.  Shown are a large number of globular or orbicular-ovate yeasts of budding daughter cell, with collar structure around the budding.

Razor Bumps or Pseudofolliculitis Barbae

This is a skin irritation caused by ingrown hairs. It mainly affects men with curly hair who shave too close and is most noticeable on the face and neck. People who get bikini waxes may develop barber's itch in the groin area. This condition may leave dark raised scars (keloids).

This CDC Photo reports: patient presented to a clinical setting with what appeared to be a maculopapular rash on his face, primarily on his cheeks, chin, and neck. Diagnosed as pseudofolliculitis barbae (PFB), this condition occurs in areas of the body where hair is shaved. In the genital region, it is known as pseudofolliculitis pubis (PFP). Most often it occurs in cases where the hair is very curly, for after cutting, or plucking out the hair shaft, when the hair grows back, rather than growing out the normal route, it grows beneath the skin, which subsequently leads to inflammation of the hair follicle.

Forms of “Deep” Folliculitis Examples Include:

Eosinophilic Folliculitis

This type mainly affects people with HIV/AIDS. Signs and symptoms include intense itching and recurring patches of bumps and pimples that form near hair follicles of the face and upper body. Once healed, the affected skin may be darker than the skin was previously (hyperpigmented). The cause of eosinophilic folliculitis isn't known.

Boils/Furuncles and Carbuncles

These occur when hair follicles become deeply infected with staph bacteria. A boil usually appears suddenly as a painful pink or red bump. A carbuncle is a cluster of boils.

Gram-negative Folliculitis

This type sometimes develops if you're receiving long-term antibiotic therapy for acne.

Ingrown hairs, folliculitis or boils themselves are not contagious, though any germ causing agents that contributed to the condition (i.e. bacteria or yeast) could be “contagious”.  Most of this bacteria and yeast is naturally found on human skin; however, under the right conditions in broken skin, these germs can fester into uncomfortable, unsightly or even serious infection.

Do not work on or around broken skin or areas of infection.  Skin integrity is broken with folliculitis, and at extreme exposure for infection. As always, it is best to seek physician approval and/or direction for serious infections or medical conditions.

[i] Mayo Clinic Staff. “Symptoms and Causes.” Mayo Clinic, Mayo Foundation for Medical Education and Research, Retrieved on: 6 May 2018, www.mayoclinic.org/diseases-conditions/folliculitis/symptoms-causes/syc-20361634?p=1.