Understanding and Treating Folliculitis: A Comprehensive Guide

January 3, 2024

Man looking at folliculitis on neck in the mirror

A common condition that can impact anyone, folliculitis is often easy to treat or prevent, but understanding the cause and type of folliculitis is essential. According to Dr. Neel Patel of U.S. Dermatology Partners in Phoenix and Scottsdale, Arizona, “Before attempting to treat your folliculitis, you should work with a dermatologist to receive an accurate diagnosis and develop an effective treatment plan.” In this blog, Dr. Patel provides a comprehensive guide for understanding and treating folliculitis.

What Is Folliculitis?

The hair follicles are small pathways within the skin where hair grows. Folliculitis occurs when these hair follicles become inflamed or infected, creating bumps or pimples that can be itchy, pus-filled, or painful. We often think that all pimples are related to acne or “ingrown hairs”, but ruling out an infectious process is essential for a successful outcome.  For many, this condition is mild and clears up on its own, but this condition can also progress to become very severe.

Causes of Folliculitis

According to Dr. Patel, “It’s so important to understand the underlying cause of folliculitis and rule out an infection before beginning treatment. Each type of folliculitis will respond to different treatments and preventive steps, so during your consultation visit, a dermatologist will ask a series of questions and perform testing such as a culture to ensure they make an accurate diagnosis and provide the best possible care.” The three most common causes of folliculitis are:

  • Infections – Bacterial, viral, and fungal infections in the hair follicle can all cause folliculitis flare-ups.
  • Acne: Acne looks like folliculitis and responds to treatment well by addressing the blocked pores that contribute to the inflammation
  • Hair removal – Frequent shaving and waxing can cause hair follicle damage and irritation that leads to folliculitis flare-ups.

In addition to these causes of folliculitis, numerous factors can increase the risk for folliculitis, including having a higher body mass, struggling with chronic skin conditions like acne or dermatitis, immune suppression, and having curly or kinky hair texture.

Types of Folliculitis

While folliculitis is often referred to as just one thing, there are actually several different types of folliculitis, including:

  • Staphylococcus Aureus Folliculitis – This is a very common form of folliculitis. It looks like tender, red bumps on the skin, often with a pustule around the hair follicle. People often mistake this diagnosis for “ingrown hairs.” The bacteria is contagious and can spread on the skin and sometimes to others.  Topical and oral medications are often necessary to clear the condition.
  • Eosinophilic Folliculitis – This type of folliculitis develops in infants who do not have strong immune systems and those with immune system disorders. This type of folliculitis causes the development of itchy pustules.
  • Gram-Negative Folliculitis – This type of folliculitis is directly related to acne. It occurs when prolonged antibiotic treatment for acne causes the body to become resistant to antibiotics, allowing bacteria to spread and infect the hair follicles.
  • Malassezia or Pityrosporum Folliculitis – This type of folliculitis often resembles acne breakouts, but it’s actually caused by naturally occurring yeast that infect the hair follicles. Rather than being tender, the bumps often itch. It is often found on the upper body and face and occurs with prolonged exposure to warm temperatures.
  • Pseudo-folliculitis or Sycosis Barbae – This condition is also called razor burn. It’s the type of folliculitis caused by shaving. People with curly and kinky hair are much more likely to develop this form of folliculitis. Shaving in the opposite direction of the hair growth also contributes. Appropriate shaving methods and laser hair removal can be helpful for this condition.
  • Pseudomonas Aeruginosa “Hot Tub” Folliculitis – This type of folliculitis is a bacterial infection specifically caused by Pseudomonas bacteria that live in warm water like hot tubs. Symptoms develop a few days after exposure and usually clear up without treatment. The pimples are tender and red and often occur under the bathing suit.

Symptoms of Folliculitis

Many of the symptoms of individual types of folliculitis are described above, but folliculitis symptoms that are common across types include:

  • Bumps or pimples around hair follicles, often developing in small clusters
  • Itchy, burning, or irritated skin
  • Painful, tender, or inflamed skin
  • Pus-filled sores that may burst and crust over

Diagnosis and Treatment

When it comes to diagnosis, Dr. Patel says, “Folliculitis is almost always diagnosable through physical examination. In some cases, I may swab a specific sore to check for viral, bacterial, or fungal infection or any other underlying concerns. From there, I will partner with my patients to develop a folliculitis treatment plan. First, we’ll work together to determine the cause of folliculitis to ensure proper treatment.”

Some of the common treatments recommended for folliculitis include:

  • Antibiotics – Creams or oral antibiotics may be recommended for bacterial infections related to folliculitis.
  • Antifungals – For yeast infections that lead to folliculitis, topical antibiotic treatments may be beneficial.
  • Steroids – Topical steroids may be recommended for itching, inflammation, and irritation related to folliculitis, as well as to address eosinophilic folliculitis caused by immune system disorders. Oral steroids may be prescribed for a viral infection that leads to folliculitis.

Prevention Tips

Folliculitis is usually preventable, or, at the very least, there are ways to reduce the impact of this condition on your skin. Dr. Patel offers the following tips for preventing folliculitis flare-ups:

  • Maintain a consistent skincare regimen – At a minimum, you should use a cleanser, moisturizer, and sunscreen in the morning. Sometimes, an evening retinoid can be helpful. Additional steps and products may be recommended by your dermatologist.
  • Change shaving routines – Shaving is one of the leading causes of folliculitis flare-ups, so make sure to take care when shaving. Always shave after your shower so the hairs are soft and easy to cut. Use a good shave cream or gel to protect the skin, shave in the direction of hair growth, use sharp and clean blades, and rinse blades regularly. Use razors with 3 or fewer blades.  Too close of a shave can worsen the condition.  After shaving, apply a gentle, lightweight moisturizer.
  • Explore other hair removal options – Because shaving and waxing can trigger folliculitis flare-ups, it may be beneficial to consider other hair removal approaches. Specifically, laser hair removal offers long-lasting results with significantly less risk for skin irritation and folliculitis flare-ups.
  • Avoid potential bacteria sources – Exposing skin to bacteria in hot tubs, pools, and saunas can significantly raise your risk for folliculitis flare-ups. Tight clothing can also trap sweat and bacteria against the skin and cause inflammation due to rubbing fabric against the skin, so wearing loose, breathable fabrics can reduce the risk of folliculitis.

When to See a Dermatologist for Folliculitis

Any time you want professional support for healing folliculitis or managing symptoms, you should reach out to a dermatologist. Dermatologic treatment is recommended for folliculitis sufferers in the following situations:

  • Managing chronic symptoms
  • Healing severe folliculitis flare-ups
  • Addressing folliculitis symptoms that last more than a few days without improvement
  • Addressing boils, carbuncles, and other pustules that develop

Managing Folliculitis Is Essential

The most important way to manage folliculitis is to keep skin healthy through consistent, effective skincare. According to Dr. Patel, “Those who struggle with folliculitis should work with a dermatologist to develop a skincare routine you can utilize each morning and evening to manage folliculitis symptoms and keep the skin comfortable and calm.”

Work with a Skincare Professional

Dealing with persistent or severe folliculitis? Don’t wait. Reach out to our dermatology experts today for personalized care and treatment options. At U.S. Dermatology Partners, our knowledgeable dermatologists can help you better understand your skin health and work to achieve and maintain beautiful skin. When you’re ready to start working with a skilled dermatologist, reach out to us using our simple online scheduling form. Once we hear from you, our team members will be in touch to finalize the details of your visit.


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