Folliculitis

The indicators and symptoms of folliculitis encompass:

• Clusters of tiny bumps or pimples around hair follicles
• Pus-filled blisters that break open and crust over
• Itchy, burning skin
• Painful, tender skin
• An inflamed bump

Types of folliculitis with the most common listed first

• Bacterial folliculitis: This prevalent form manifests as an itchy rash with pus-filled lumps, typically due to an infection from Staphylococcus aureus bacteria. Staph bacteria are generally harmless residents of the skin but can become problematic if they enter the body through a cut or similar wound.
• Hot tub rash (Pseudomonas Folliculitis): This variant presents itself as round, itchy bumps that emerge 1 to 2 days post-exposure to Pseudomonas bacteria. These bacteria are usually found in hot tubs, water slides, or heated pools where chlorine and pH levels are improperly maintained.
• Razor bumps (Pseudofolliculitis Barbae): Although resembling folliculitis, this rash is caused by ingrown hairs rather than infected follicles. It predominantly affects individuals with curly hair who shave too closely and is most evident on the face and neck. It can also occur in the groin area after bikini waxes.
• Pityrosporum folliculitis: This type features an itchy rash with pus-filled lumps, commonly found on the back and chest. The cause is typically a yeast infection.
• Gram-negative folliculitis: This form produces pus-filled lumps around the nose and mouth area and often occurs in individuals undergoing long-term antibiotic treatment for acne.
• Eosinophilic folliculitis: Characterized by intense itching and recurring patches of bumps and spots near the hair follicles, primarily on the face and upper body. This type mainly impacts people with HIV/AIDS, although its exact cause is not entirely understood.
• Boils (Furuncles) and carbuncles: These emerge when staph bacteria deeply infect hair follicles. A boil surfaces abruptly as an inflamed, painful lump. A carbuncle, on the other hand, is a collection of boils.
• Sycosis barbae: This type is specific to individuals who shave and often involves more severe symptoms.

Each of these types of folliculitis has its own set of symptoms, causes, and appropriate treatment methods. Recognising the specific type is crucial for effective management.

If your symptoms are extensive or persist for more than a week or two despite employing essential self-care, you should book an appointment with your healthcare provider. You may require medication of prescription strength, an antibiotic or antifungal treatment to manage your condition effectively.

Emergency medical attention

If you notice indicators of a spreading infection, seek immediate medical intervention. Symptoms to watch for include:

• A sudden escalation in redness or discomfort
• The presence of fever or chills
• A general sense of malaise or feeling unwell

In such cases, prompt medical evaluation and treatment are crucial to prevent complications. Your healthcare provider may undertake diagnostic tests to identify the specific pathogen causing the infection and prescribe appropriate medication.

Primary causes include:

Folliculitis is commonly instigated by bacterial infection, specifically Staphylococcus aureus (staph). However, other agents can also be responsible, including:

• Viruses
• Fungi
• Parasites
• Medications
• Physical injury

Occasionally, the underlying cause may remain unidentified.

When hair follicles sustain damage, they become vulnerable to invasion by various microorganisms like viruses, bacteria, and fungi, which can trigger the onset of folliculitis. The condition can be categorised into two main types based on the depth of follicle involvement:

• Superficial folliculitis: This form impacts the upper section of the hair follicle as well as the surrounding skin.
• Deep folliculitis: This is a more severe form that affects a larger portion or even the entirety of the hair follicle.

Though folliculitis can affect anyone, some specific conditions and practices elevate the likelihood of contracting it.

Clothing and environment

Regularly use attire that locks in heat and sweat, like rubber gloves or high boots.

Immersing oneself in poorly maintained hot tubs, whirlpools, or public swimming pools.

Personal grooming and styling practices

Inflicting damage to hair follicles via shaving, waxing, or wearing tight clothing.

Employing hair-styling techniques that stress the hair follicles, such as traction or wigs and oils.

Medication usage

Application of certain medications like corticosteroid creams, prednisone, long-term antibiotics for acne, or specific chemotherapy drugs.

Pre-existing medical conditions

Presence of dermatological issues like dermatitis or bodily conditions like excessive sweating (hyperhidrosis).

Having chronic diseases such as diabetes, HIV/AIDS, or any other conditions that compromise the immune system reduces resistance to infections.

Hygiene practices

Wash your skin regularly and always use a clean washcloth and towel; avoid sharing these items.

Regularly do laundry, using hot, soapy water for towels, washcloths, and any oil-soaked garments.

Clothing and equipment

Prevent friction or pressure on the skin by avoiding tight clothes and using padded straps for backpacks and helmets.

If you use rubber gloves frequently, turn them inside out after each use, wash them with soap, rinse, and dry them thoroughly.

Shaving and hair removal

Avoid shaving altogether; consider growing facial hair if it aligns with your lifestyle.

If you must shave, implement these precautions:

• Shave less frequently.
• Prep your skin using a mild facial cleanser and warm water.
• Use a washcloth or cleansing pad to dislodge embedded hairs before shaving.
• Apply a generous layer of shaving lotion.
• Shave in the direction of hair growth.
• Use an electric razor or a guarded blade to avoid shaving too closely.
• Ensure the blade is sharp and clean; rinse it after each stroke.
• Limit shaving each area to a maximum of two passes.
• Apply a moisturising lotion post-shave.

Additional considerations

• Opt for depilatories or other hair removal methods, but be cautious as they irritate the skin.
• If underlying conditions like hyperhidrosis contribute to folliculitis, address these with relevant treatments such as antiperspirants.
• Use only well-maintained hot tubs and heated pools. Follow guidelines set by the Centers for Disease Control, which include showering with soap after swimming and washing your swimsuit.

Medical consultation

For recurring folliculitis, consult your healthcare provider for specialised advice. You might need a short course of prescription antibacterial ointment or a chlorhexidine body wash.

Adherence to these guidelines can significantly reduce the risk of developing folliculitis and manage existing symptoms more effectively.