Folliculitis

Overview

Folliculitis is a common skin condition in which hair follicles become inflamed, often caused by an infection with bacteria. It can appear as small pimples around the hair follicles, and may be itchy, sore, and embarrassing. The infection can spread, turning into crusty sores. Mild cases may heal without scarring in a few days with basic self-care, but more severe or recurrent infections may require prescription medication. Certain types of folliculitis include hot tub rash and barber's itch.

Understanding the disease

Symptoms

Symptoms of folliculitis include clusters of small bumps or pimples around hair follicles, pus-filled blisters that break open and crust over, itchy, burning skin, painful, tender skin, and an inflamed bump. Folliculitis can be caused by bacterial infections, friction or pressure on the skin, wearing tight clothing, sharing personal items, and using certain medications. Complications of folliculitis can include recurrent or spreading infection, permanent scarring, and hair loss. Prevention methods include regularly washing your skin, doing laundry regularly, avoiding friction or pressure on the skin, drying out rubber gloves, and avoiding shaving if possible. If the symptoms persist or worsen, it is best to see a healthcare provider.

Risk Factors

The risk factors for developing folliculitis include regularly wearing clothing that traps heat and sweat, such as rubber gloves or high boots, and causing damage to hair follicles through shaving, waxing, wearing tight clothes, or hair styling practices such as traction, wigs, and oils. Other risk factors include using certain medications, having dermatitis or excessive sweating (hyperhidrosis), having diabetes, HIV/AIDS, or another condition that lowers your resistance to infections. Additionally, those who frequently soak in hot tubs, whirlpools, or public pools that aren't well-maintained are also at a higher risk of developing folliculitis.

Development

Folliculitis can develop in various ways due to different causes. The most common cause is an infection with bacteria, particularly Staphylococcus aureus (staph), which enters the hair follicles through cuts or wounds in the skin. It can also be caused by viruses, fungi, parasites, certain medications, or physical injury. The two main types of folliculitis are superficial and deep. Superficial folliculitis affects part of the hair follicle, while deep folliculitis involves the entire follicle and is usually more severe. Factors that increase the risk of developing folliculitis include regularly wearing clothing that traps heat and sweat, soaking in poorly maintained hot tubs or public pools, causing damage to hair follicles through shaving, waxing, or tight clothing, using certain medications, having dermatitis or excessive sweating, and having diabetes, HIV/AIDS, or another condition that weakens the immune system.

Assessment and Diagnosis

Triage

You should see a doctor if your folliculitis is widespread or the symptoms don't go away after a week or two of self-care measures. Additionally, seek immediate medical care if you experience signs of a spreading infection, such as a sudden increase in redness or pain, fever, chills, and a feeling of being unwell (malaise). Your healthcare provider may prescribe a prescription-strength antibiotic or antifungal medication to help control the condition.

Diagnosis

To diagnose folliculitis, a healthcare provider typically examines the affected skin and inquires about the patient's medical history. If early treatments don't clear up the infection, the provider may run tests such as scraping the skin to look for yeast under a microscope, obtaining a swab for culture, or rarely, performing a skin biopsy to rule out other conditions.

Management and Treatment

Complications

Possible complications of folliculitis include recurrent or spreading infection, permanent scarring, patches of skin that are darker or lighter than before the condition occurred (usually temporary), and destruction of hair follicles leading to permanent hair loss.

Prevention

folliculitis can be prevented by following these tips:

1. Wash your skin regularly with warm water and a mild facial cleanser, and use a clean washcloth and towel each time.
2. Do laundry regularly, using hot, soapy water to wash towels, washcloths, and any oil-soaked uniforms or clothing.
3. Avoid friction or pressure on your skin, and protect your skin from the friction caused by backpacks, helmets, and tight clothes.
4. Dry out your rubber gloves between uses by turning them inside out, washing with soap, rinsing, and drying well.
5. Avoid shaving if possible or adopt healthy shaving habits, such as shaving less often, washing your skin with warm water and a mild facial cleanser before shaving, and avoiding sharing razors, towels, and washcloths.
6. Try alternative hair-removing products or methods.
7. Treat related conditions, such as excessive sweating, dermatitis, or other infections.
8. Use only clean hot tubs and heated pools, and shower with soap after swimming. By following these preventive measures, you can help reduce the risk of developing folliculitis.

Home Remedies

Here are some home remedies suggested for folliculitis:

1. Wash your skin regularly: Keep the affected area clean by washing it with warm water and a mild facial cleanser (e.g., Cetaphil, CeraVe). Use a clean washcloth and towel each time and avoid sharing towels or washcloths.
2. Use over-the-counter creams: Apply an over-the-counter topical antibiotic cream or creams containing benzoyl peroxide to help reduce inflammation and bacterial growth. Follow the instructions on the packaging and finish the full course.
3. Apply a warm compress: Soak a clean cloth in warm water and apply it to the affected area for 10-15 minutes, three to four times a day. This can help reduce itching and soothe the skin.
4. Take over-the-counter pain relievers: Use pain relievers like ibuprofen or acetaminophen to help alleviate discomfort and reduce inflammation. Follow the dosage instructions on the packaging and consult your healthcare provider if you have any concerns.
5. Avoid irritating the skin: Refrain from shaving the affected area, as this can worsen the condition. If you must shave, use a clean razor and apply shaving cream or oil to reduce friction. Avoid tight clothes and protective gear that causes friction or pressure on the affected area.
6. Keep the area dry: Pat the affected area dry with a clean towel after washing and avoid exposing it to water sources like hot tubs or heated pools. Remember, if your folliculitis does not improve or worsens, consult your healthcare provider for further evaluation and treatment.

Treatment

For mild folliculitis, basic self-care and home remedies may be enough for the condition to heal without scarring in a few days. Treatment options for folliculitis include:

1. Warm compresses: Applying warm, moist compresses to the affected area can help reduce inflammation and promote healing.
2. Over-the-counter products: Topical antibiotics, such as Bactroban, Neosporin, or Polysporin, can help treat the infection. For fungal folliculitis, antifungal creams like Clotrimazole or Terbinafine can be used.
3. Good hygiene: Keep the affected area clean and dry, and avoid sharing towels, washcloths, or razors with others.
4. Prescription medications: For more severe or recurring cases, a healthcare provider may prescribe oral antibiotics or topical prescription medications.
5. Lifestyle changes: Avoid friction, pressure, and irritation on affected skin, and protect your skin with loose clothing. For permanent hair loss, the best option is to prevent the condition from occurring. Adopting self-care measures, such as proper hygiene, avoiding friction or pressure on the skin, and using clean razors and towels, can help prevent folliculitis and minimize the risk of hair loss.

Preparing for medical consultation

To prepare for an appointment for folliculitis, you can follow these steps:

1. Note your symptoms: Write down any symptoms you're experiencing, including the location of the affected areas, any itchiness, redness, or swelling. Also, mention any recent skin irritations, such as shaving or wearing tight clothing.
2. Review your medical history: Prepare a list of your key medical information, including any other skin conditions, allergies, or previous treatments for folliculitis.
3. List medications and supplements: Make a list of all the medications, vitamins, or supplements you're currently taking, including any topical treatments or creams you've applied to the affected area.
4. Gather relevant information: If you've noticed any triggers for your folliculitis, such as a new skincare product or increased sweating, bring that information to your appointment.
5. Prepare questions: Compile a list of questions to ask your healthcare provider during the appointment. Some questions to consider include the cause of your folliculitis, the most appropriate treatment options, and any lifestyle changes that may help prevent future occurrences. By preparing for your appointment and gathering this information, you'll be better equipped to discuss your folliculitis with your healthcare provider and receive the most appropriate treatment.