Folliculitis is a common skin condition that occurs when hair follicles become inflamed, typically due to infection, irritation, or blockage. This inflammation is most often caused by a bacterial or fungal infection, but it can also be caused by physical irritation or blockage.

Think of each hair on your body as a small plant growing out of a tiny pot (the follicle) in your skin. Folliculitis is what happens when this “pot” gets damaged, clogged, or infected with bacteria. The follicle becomes red, swollen, and inflamed, often forming a small, pus-filled pimple right at the base of a hair.

Folliculitis can occur anywhere on the body where there is hair, including the scalp, face, beard area, chest, back, arms, legs, and buttocks. It is generally classified into two main categories based on the depth of the inflammation:

• Superficial Folliculitis: This is the most common form, affecting only the upper part of the hair follicle. It appears as small, red bumps or white-headed pustules, is usually mild, and typically heals without scarring.
• Deep Folliculitis: This involves the inflammation of the entire follicle and the surrounding deeper tissue. It is more painful and can cause the formation of a larger, tender lump called a furuncle (boil). A cluster of interconnected boils is known as a carbuncle. Deep folliculitis is more likely to leave a scar.

In my experience, patients often think they have acne or a rash, but folliculitis is often caused by friction, shaving, or sweating, especially in warm, humid climates.

Folliculitis is caused by damage to the hair follicle, which creates an opening for common skin organisms to invade and cause an infection or inflammation. A variety of organisms and factors can be responsible.

Infectious Causes (Most Common)

• Bacterial Folliculitis: This is the most frequent type.
  • Staphylococcus aureus (Staph): This bacterium is the number one cause. Staph bacteria live harmlessly on the skin of many people but can cause an infection when they enter the body through a cut or scrape (American Academy of Dermatology [AAD], n.d.).
  • Pseudomonas aeruginosa: This bacterium is the culprit behind a specific variant known as “hot tub folliculitis.” It thrives in warm, wet environments where chlorine and pH levels are not well-regulated, such as in poorly maintained hot tubs, jacuzzis, or heated pools.
• Fungal (Yeast) Folliculitis:
  • Pityrosporum (or Malassezia) Folliculitis: This common type is caused by a yeast that is a normal inhabitant of the skin. An overgrowth of this yeast can lead to an itchy, acne-like eruption, typically on the upper chest, back, and shoulders. It is often seen in hot, humid environments.
• Viral Folliculitis: Less commonly, viruses can infect the hair follicle. The herpes simplex virus, which causes cold sores, can sometimes lead to herpetic folliculitis around the mouth.

Non-Infectious Causes Sometimes, the inflammation is not caused by an infection but by physical irritation.

• Pseudofolliculitis Barbae (“Razor Bumps”): This is one of the most common non-infectious types, particularly affecting men with curly hair in the beard area. It is caused by shaved hairs that are cut so short that they curl back and grow into the skin, causing an inflammatory reaction.
• Eosinophilic Folliculitis: This is a specific type of recurring folliculitis that causes intense itching, primarily seen in individuals with weakened immune systems, such as those with HIV/AIDS.

Clinically, I always ask about shaving habits, recent travel, or gym use. These often reveal the trigger behind a flare-up of folliculitis.

You can develop folliculitis when hair follicles are damaged or blocked, making them more susceptible to infection or inflammation. Many common situations and lifestyle factors can increase your risk.

Key risk factors that can lead to follicle damage and infection include:

• Hair Removal Practices: Shaving, particularly with a dull blade, against the direction of hair growth, or without proper lubrication, is a major cause. Waxing and plucking can also damage follicles.
• Friction and Irritation: Wearing tight clothing, especially non-breathable fabrics during exercise, can trap heat and sweat and cause constant rubbing that irritates hair follicles.
• Excessive Sweating: A hot, humid climate or intense physical activity creates a moist environment where bacteria and yeast can thrive.
• Occlusion of the Skin: Applying thick oils, moisturizers, or tar-based products can block hair follicles.
• Pre-existing Skin Conditions: Acne or dermatitis.
• Weakened Immune System: From diabetes, HIV, or immunosuppressant drugs.
• Using unclean hot tubs, jacuzzis, or pools.

Patients often say, “It started after I shaved or after the gym,” which are classic clues, folliculitis loves warm, moist environments and irritated skin.

The signs and symptoms of folliculitis can vary depending on the depth and cause of the inflammation.

The most common presentation is that of superficial folliculitis, which includes:

• Clusters of small red bumps or white-headed pimples that develop around individual hair follicles.
• Pus-filled blisters (pustules) that may break open, ooze, and then crust over.
• Itching or burning skin in the affected area.
• Pain or tenderness.

Deep folliculitis involves more severe symptoms:

• A large, swollen, painful bump or mass that develops deep under the skin (a furuncle or boil).
• The potential for the infection to spread and form a cluster of boils (a carbuncle).
• Higher chance of scarring after the lesion heals.

Specific types of folliculitis can have a characteristic appearance. For example, hot tub folliculitis often presents as a widespread rash of red, itchy bumps on the torso, while Pityrosporum folliculitis typically appears as uniform, acne-like itchy pustules on the chest and back.

Clinically, I often find that patients ignore it until it becomes painful or spreads, early care often prevents scarring and recurring outbreaks.

When to See a Doctor

Many mild cases of folliculitis will resolve on their own with simple home care. However, you should see a doctor or dermatologist if the condition:

• Is widespread or spreading.
• Does not improve after about a week of self-care measures.
• Is very painful, or if the bumps are getting larger and forming a boil.
• Is accompanied by a fever or feeling unwell.

Diagnosis

Diagnosis is usually based on visual examination and medical history. In persistent or unclear cases, a skin swab or culture may be taken to identify the exact organism causing the infection.

• A doctor can almost always diagnose folliculitis based on a physical examination of the skin and a review of your recent activities and medical history.
• A doctor might use a dermatoscope for a closer look.
• If the infection is recurrent or not responding to standard treatment, the doctor may take a bacterial or fungal culture. This involves taking a swab of the pus or scraping the skin to identify the specific organism causing the infection. This is particularly important if MRSA or fungal folliculitis is suspected.
• A skin biopsy is rarely needed.

I tell patients we usually don’t need elaborate tests unless it keeps coming back or doesn’t respond to initial treatments.

Treatment depends on the cause, severity, and extent of the condition. Most cases are mild and clear with basic hygiene and topical treatments.

1. Home Care and Self-Treatment (For mild cases)

• Warm Compresses: Applying a warm, moist cloth to the affected area for 15-20 minutes several times a day can help soothe discomfort and encourage pus-filled lesions to drain.
• Antibacterial Soaps/Washes: Using a benzoyl peroxide or chlorhexidine wash.
• Stop Irritating Activities: Temporarily stop shaving or wearing tight clothes.
• Keep the area clean and dry.

2. Medical Treatment

• Topical Medications: Prescription antibiotic lotions or creams (clindamycin, mupirocin). For fungal folliculitis, topical antifungal creams (ketoconazole).
• Oral Medications: For widespread or deep infections, oral antibiotics (like cephalexin) or oral antifungals (like fluconazole) are necessary.
• Incision and Drainage: A doctor will need to drain a large boil or carbuncle.

3. Prevention

Preventing folliculitis revolves around reducing the risk factors that damage hair follicles.

• Practice Smart Shaving:
  • Always shave in the direction of hair growth, not against it.
  • Use a sharp, clean blade for every shave.
  • Wet the skin with warm water and use a lubricating shaving cream or gel.
  • Consider alternatives like an electric razor or other hair removal methods.
• Clothing: Wear loose, breathable clothing, especially in hot, humid weather.
• Hygiene: Shower after exercising or sweating heavily.
• Hot Tubs/Pools: Only use well-maintained facilities. Shower with soap after getting out.

In my clinic, the most common success story comes from patients switching to electric razors, practicing gentle hygiene, and treating early. This breaks the cycle before it worsens.

Folliculitis is a common inflammation of hair follicles, usually caused by a bacterial infection of a damaged follicle. It is often linked to friction, shaving, and sweaty conditions. While most cases are mild and respond to simple hygiene and home care, persistent or deep infections require medical treatment with prescription medications to prevent complications like boils and scarring. The best approach is prevention. By adopting smart shaving habits, wearing loose clothing in the heat, and practicing good hygiene, you can significantly reduce your risk of developing this common but frustrating skin ailment.

American Academy of Dermatology (AAD). (n.d.). Folliculitis: Overview. Retrieved from https://www.aad.org/public/diseases/a-z/folliculitis-overview

Cleveland Clinic. (2023). Folliculitis. Retrieved from https://my.clevelandclinic.org/health/diseases/17692-folliculitis

Mayo Clinic. (2022). Folliculitis. Retrieved from https://www.mayoclinic.org/diseases-conditions/folliculitis/symptoms-causes/syc-20361634