Topic Overview

What is folliculitis?

Folliculitis is an infection in the hair follicles. Each hair on your body grows out of a tiny pouch called a follicle. You can have folliculitis on any part of your body that has hair. But it is most common on the face and scalp and areas rubbed by clothing, such as the thighs and groin.

What causes folliculitis?

It usually is caused by bacteria. It also can be caused by yeast or another type of fungus.

You may get folliculitis if you have damaged hair follicles. Shaving or wearing clothes that rub the skin can irritate the follicles, which can lead to folliculitis. They also can become blocked or irritated by sweat, machine oils, or makeup. When the follicles are injured, they are more likely to become infected.

You are more likely to get folliculitis if you:

• Use a hot tub, whirlpool, or swimming pool that is not properly treated with chlorine.
• Wear tight clothes.
• Use antibiotics or steroid creams for long periods.
• Use or work with substances that can irritate or block the follicles. Examples include makeup, cocoa butter, motor oil, tar, and creosote.
• Have an infected cut, scrape, or surgical wound. The bacteria or fungi can spread to nearby hair follicles.
• Have a disease such as diabetes or HIV that lowers your ability to fight infection.

What are the symptoms?

Folliculitis usually looks like red pimples with a hair in the center of each one. The pimples may have pus in them, and they may itch or burn. When the pimples break open, they may drain pus, blood, or both.

How is folliculitis diagnosed?

Your doctor will check your skin and ask about your health and activities. He or she may do tests to find out what is causing your folliculitis and to make sure you don’t have a different problem, such as impetigo or heat rash. Testing a sample of the fluid in the pimples or a sample of tissue can help your doctor learn what is causing the infection.

How is it treated?

Mild folliculitis usually heals on its own in about 2 weeks. Warm compresses made with white vinegar or Burow's solution may ease itching and help healing. If the infection does not go away, you may need an antibiotic or antifungal cream. Medicated shampoo can be used to treat folliculitis on the scalp or beard. If your infection is severe, your doctor will prescribe antibiotic or antifungal pills.

Call your doctor if you have folliculitis and:

• It spreads or keeps coming back.
• You have a fever over 101°F (38°C).
• The infected area becomes red, swollen, warm, or more painful.

If the infection does not go away or keeps coming back, laser hair removal may be an option. Laser treatment destroys the hair follicles so they can't get infected.

How can you prevent folliculitis?

There are many things you can do to prevent folliculitis or keep it from spreading:

• Bathe or shower daily with a mild antibacterial soap. Also, bathe or shower after you exercise and after you work around chemicals.
• Avoid sharing towels, washcloths, or other personal items. If you have folliculitis, use a clean washcloth and towel each time you bathe.
• Don't scratch the bumps.
• Wash your hands and under your fingernails often.
• Avoid shaving the bumps. If you must shave, change the razor blade each time. Try using depilatory creams and lotions, which remove hair without shaving. These products are not recommended for use more often than once or twice a week.
• Wear loose-fitting clothing. Tight clothes trap sweat and bacteria on your body.
• Avoid using oils on your skin. Oils can trap bacteria in the pores of your skin and can cause folliculitis.
• Use a mild deodorant. Strong deodorants may cause folliculitis or make it worse.
• After you use public hot tubs or spas, shower right away with antibacterial soap. If you own your own hot tub, follow the manufacturer's instructions for keeping it clean.

Frequently Asked Questions

Learning about folliculitis:	What is folliculitis? What causes it? What are the symptoms?
Being diagnosed:	How is it diagnosed?
Getting treatment:	How is folliculitis treated? What can I do at home?
Ongoing concerns:	How can I prevent folliculitis?

Symptoms

Folliculitis begins as a red, tender area at or near the base of one or more strands of hair. It turns into a small, raised area of skin that contains pus (pustule) and often itches or burns. When these pustules break open, they may drain pus and/or blood.

The pustules that develop with deep folliculitis are usually larger, more painful, and longer-lasting than those from mild (superficial) folliculitis. Deep folliculitis can also lead to other skin infections that generally cause more pain and discomfort, such as a boil (furuncle) or carbuncle. Carbuncles may also cause a fever and make you feel ill.

"Hot tub folliculitis" typically appears about 72 hours after you have been in a hot tub or spa. Many small pustules appear on your torso and sometimes your arms and legs. You may have a mild fever and feel ill. This type of folliculitis usually goes away on its own within 7 to 10 days.

Some people get razor bumps. These are not folliculitis. Razor bumps are most common in African Americans and people with tightly coiled hair. They develop after the person shaves, when strands of hair curl back on themselves, grow into the skin, cause irritation, and make pimples.

Other skin conditions that cause symptoms similar to folliculitis include poison ivy, acne, and heat rash.

Exams and Tests

If your doctor thinks that you have folliculitis, he or she will examine the skin over your entire body, especially on your arms, legs, buttocks, and scalp. If you are a man, your doctor will also examine the skin of your beard. In general, a doctor will suspect folliculitis if he or she finds hairs in the center of pus-filled pimples (pustules).

If folliculitis is diagnosed and it is severe, your doctor may do testing to find out what is causing the infection. Most cases of folliculitis are caused by bacteria, most commonly by a type called Staphylococcus aureus. It can also be caused by a fungus, such as Candida albicans.

• If your doctor suspects bacteria is causing your infection, he or she may take a sample of the fluid from inside a pustule to identify the type of bacteria. The fluid is sometimes analyzed right at the doctor's office, in which case the results are available right away.
• To diagnose a fungus, the doctor will take a tissue sample, or biopsy, of the infected area. If fluid or biopsy samples are sent to an outside lab, you will get the results in a few days.

Treatment Overview

Mild cases of folliculitis sometimes heal on their own. But folliculitis may return or get worse. If your folliculitis spreads or returns, see your doctor for treatment.

If your infection is caused by bacteria and it is:

• Mild, you can try an antibiotic ointment or cream such as bacitracin, polymyxin B (Polysporin), clindamycin, erythromycin, or mupirocin (Bactroban). You may also use an antiseptic cleanser, such as povidone-iodine (for example, Betadine) or chlorhexidine.
• Deeper or more severe, you will need to take antibiotic pills. Your doctor may prescribe dicloxacillin, erythromycin, or cephalexin (such as Keflex). Ciprofloxacin (Cipro) and ofloxacin (such as Floxin) are used for certain types of bacteria.

If your infection is caused by a fungus:

• You will need to take antifungal pills, such as fluconazole (Diflucan), griseofulvin (Gris-PEG, for example), itraconazole (Sporanox), or terbinafine (Lamisil).
• Your doctor may give you a corticosteroid to reduce inflammation.

If folliculitis occurs on your scalp or beard area, you can use a shampoo containing selenium.

For stubborn or recurrent cases of folliculitis, laser treatment may be an option. Laser treatment destroys the hair follicle and reduces the scarring that results from folliculitis. But hair will no longer grow in the treated area. Laser treatment is expensive.

Home Treatment

If you have folliculitis, try the following measures:

• Use an antibacterial soap to wash the infected area. If the infection is on your scalp or beard, use a shampoo containing selenium or propylene glycol.
• Apply warm, wet compresses 3 to 6 times a day to help folliculitis heal faster and stop the itching or pain. Wash your hands before applying a compress. To make a compress, moisten a clean cloth or piece of gauze with warm water. Place it over the infected area until it begins to cool (usually 5 to 10 minutes). You can make compresses with:
  • Burow's solution, which you can buy without a prescription in many drugstores and supermarkets.
  • White vinegar solution. Mix 1 Tbsp (15 mL) of white vinegar and 1.33 cups (314.66 mL) of water.

When to call a doctor

If you have folliculitis, call your doctor if:

• It spreads or keeps coming back.
• You develop other symptoms, such as fever over 101°F (38°C), redness, swelling, warmth, or increased pain over the infected area.

Preventing folliculitis

There are a number of steps you can take to prevent folliculitis from starting, spreading, or coming back:

• Bathe or shower daily with a mild antibacterial soap. Also, bathe or shower after you exercise and after you work around chemicals.
• Avoid sharing towels, washcloths, or other personal items. If you have folliculitis, use a clean washcloth and towel each time you bathe.
• Don't scratch infected areas. Organisms that cause folliculitis can be carried under your fingernails and spread to other areas of your body or to other people.
• Wash your hands and under your fingernails often, especially when you or someone you are caring for has a skin infection.
• If you have folliculitis, avoid shaving the infected area. If you must shave, change the razor blade each time. Try using depilatory creams and lotions, which remove hair without shaving. These products are not recommended for use more often than once or twice a week.
• Wear loose-fitting clothing. Tighter clothes trap sweat and bacteria on your body.
• Avoid using oils on your skin. Oils can trap bacteria in the pores of your skin and can cause folliculitis.
• Use a mild deodorant. Strong deodorants may contribute to folliculitis.
• After you use public hot tubs or spas, shower immediately with antibacterial soap. If you own your own hot tub, follow the manufacturer's instructions for keeping it clean.

Other Places To Get Help

Organizations

American Academy of Dermatology
P.O. Box 4014
Schaumburg, IL  60618-4014
Phone:	1-866-503-SKIN (1-866-503-7546) toll-free (847) 240-1280
Fax:	(847) 240-1859
Web Address:	www.aad.org
The American Academy of Dermatology provides information about the care of skin, hair, and nails. You can find a dermatologist in your area by calling 1-888-462-DERM (1-888-462-3376).
Centers for Disease Control and Prevention (CDC)
1600 Clifton Road
Atlanta, GA  30333
Phone:	1-800-CDC-INFO (1-800-232-4636)
TDD:	1-888-232-6348
E-mail:	cdcinfo@cdc.gov
Web Address:	www.cdc.gov
The Centers for Disease Control and Prevention (CDC) is an agency of the U.S. Department of Health and Human Services. The CDC works with state and local health officials and the public to achieve better health for all people. The CDC creates the expertise, information, and tools that people and communities need to protect their health—by promoting health, preventing disease, injury, and disability, and being prepared for new health threats.

Related Information

• Acne
• Boils
• Pilonidal Disease
• Swollen Glands and Other Lumps Under the Skin

References

Other Works Consulted

• Berger TG (2008). Folliculitis (including sycosis) section of Dermatologic disorders. In SJ McPhee et al., eds., Current Medical Diagnosis and Treatment 2008, 47th ed., pp. 113–114. New York: McGraw-Hill Medical.
• Craft N, et al. (2008). Folliculitis section of Superficial cutaneous infections and pyodermas. In K Wolff et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., pp. 1698–1699. New York: McGraw-Hill Medical.
• Korman NJ (2008). Folliculitis section of Macular, papular, vesiculobullous, and pustular diseases. In L Goldman, D Ausiello, eds., Cecil Medicine, 23rd ed., p. 2956. Philadelphia: Saunders Elsevier.
• Swartz MN, Pasternack MS (2005). Folliculitis section of Cellulitis and subcutaneous tissue infections. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 6th ed., p. 1190. Philadelphia: Elsevier.

Credits

Author	Maria Essig
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Alexander H. Murray, MD, FRCPC - Dermatology
Last Updated	June 8, 2009