Folliculitis (Inflamed Hair Follicles)

Definition

Folliculitis is a conditions where the hair follicles in the skin becomes inflamed or infected. It can occur in any part of the body that contains hair but is common on the face, neck, upper chest, back, and groin regions. It is often confused with various other skin conditions, like acne vulgaris, but folliculitis is a separate disease.

It might be superficial (affecting only the upper part of the hair follicle) or deep (affecting the entire length of the hair follicle). Superficial folliculitis usually heals by itself. However, deep and recurrent folliculitis requires medical treatment. Severe damage to the skin and even scarring is possible without proper management. Sometimes the complications can be even more serious and even life-threatening.

Symptoms

Common symptoms of folliculitis include itching, reddish skin rash and bumps (which may have pus) surrounding the affected hair follicles. The bumps might be painful.

Superficial folliculitis is characterized by reddish skin rash, itchiness, and clusters of small red or pus-filled bumps around the affected hair follicles.

Deep folliculitis is characterized by large painful bumps (which may contain pus) on the skin surrounding the affected hair follicles.

Diagnosis of folliculitis is done on the basis of skin appearance. If the follicles are infected, laboratory tests can determine the infectious agent.

Causes

Inflammation of hair follicles occurs when damaged hair follicles get infected. Hair follicles may be damaged by friction from the clothes, shaving, and blockage of the follicle with sweat or sebum. Inflammation of the skin due to dermatitis or acne could also result in damage to the hair follicles. Lowered immunity increases the risk of developing folliculitis.

Superficial folliculitis

Superficial folliculitis is caused by infection of the damaged hair follicles by bacteria (Staphyloccus, Pseudomonas) or fungus. Staphylococcal infection is the most common cause of superficial folliculitis. Pseudomonas folliculitis (also known as hot tub folliculitis) happens when the Pseudomonas bacteria found in the hot water tubs infects the hair follicles. Pseudofolliculitis barbae is caused when the shaved hairs of stiff beard (particularly in people with curly hairs) curve backwards into the skin and cause inflammation. Pityrosporum folliculitis results from fungal infection of the hair follicles and occurs mostly on the skin of the chest and the back.

Deep folliculitis

Sycosis barbae is a deep folliculitis condition that results from shaving. It causes inflammation along the whole length of the follicle and worsens with repeated shaving. Boils and carbuncles (cluster of boils) may occur due to deep infection of the hair follicles by Staphylococcus. Eosinophilic folliculitis is thought to be an autoimmune reaction that occurs mainly in HIV-infected persons. It is characterized by the recurrent occurrence of pus-filled sores on the face, back and upper arms.

Treatment

In most cases, folliculitis resolves on its own with little or no treatment. However, the condition might recur or persist.  The following are the treatment options for folliculitis:

  • Moist and hot compresses on the affected skin area may help in draining the infected hair follicles. Anti-bacterial washes (like benzyol peroxide) and shampoos might help.
  • Oral or topical antibiotics (clindamycin, mupirocin, dicloxacilin, ciprofloxacin) and antifungal (terbinafine, fluconazole) drugs are given to treat infected hair follicles.

Preventive measures include keeping the skin clean, avoiding using rough and dirty clothes, and not shaving “against the grain” or on irritated skin.

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