Folliculitis is an infection of follicle, that is a bulb shaped sac like structure under the skin from which a hair grows. A hair follicle is normally surrounded by oil/sebaceous glands that help in nourishing the follicle. An infection of a hair follicle may occur by microorganisms through cuts, wounds when the opening of follicle is plugged or blocked by dry skin, oil, dust particles, etc. It generally subsides on itself in about 5-7 days or with self-care.

Folliculitis may be superficial or deep. Superficial infection may involve only a part of follicle. Whereas a deep infection may involve entire hair follicle extending deep under the skin called a boil/furuncle. If multiple boils under skin are clustered together and forms one big boil, it is called a carbuncle.

It is most commonly seen in areas such as beard, arms, shoulder, buttocks, legs, scalp.

Causes:

Folliculitis is most commonly caused by bacteria called Staphylococcus aureus, that is normally present on the skin. It can also be caused by other bacteria such as pseudomonas, viruses such as herpes, fungi such as yeast.

Risk factors:

  • Frequent shaving, waxing.
  • People with curly beard and hair, that may lead to ingrown hair (blocks the follicle opening).
  • Wearing tight fitting clothes, that may cause excessive sweating and friction of clothes. This may lead to irritation of skin and hair follicles causing minor cuts, rash.
  • Acne, dermatitis.
  • Low immunity due to Diabetes, HIV, long term therapy of antibiotics, steroids, etc.
  • Soaking in hot tubs and pools, that are poorly maintained.
  • Medications such as steroid creams, emollients, coal tar, etc. applied on skin

Symptoms:

  • Small red raised bumps with/without pus and a hair at the center of the bump.
  • Pain, tenderness over and around the bump.
  • Itch and burning sensation of skin.
  • Discharge of pus, blood or both when the bumps are open.
  • Boil and carbuncle may look bigger with pus filled bumps, nodules and are hard to touch.

The bumps if scratched, picked on may lead to spread of infection to other follicles around and scar formation.

Recurrent, chronic bumps as well may form scar.

Other skin conditions, that may look like folliculitis are acne (pimple), dermatitis/eczema, chicken skin (keratosis pilaris that looks like a bumpy skin), cyst, abscess, heat rash (prickly heat), pustular psoriasis, etc.

Management:

Folliculitis can be diagnosed by a doctor on a physical examination. However, a swab from the bump, pus may be collected for culture, if it is a boil, carbuncle or if it doesn’t subside after 10 days, recurs.

Self-care:

 

  • Avoid contact of unwashed hands over the bumps and avoid picking on or scratching the bumps.
  • Avoid, remove the source such as shaving, waxing, emollient application over skin, etc.
  • Wear loose, cotton clothes to avoid irritation of the region with tight clothes.
  • Warm compresses with Epsom salt (after squeezing off the warm water from the soft cloth) 3-4 times a day, at least for 15-20 minutes each time.
  • Apply over the counter antibiotic creams, ointments over the bumps and leave it open without covering with a bandage.
  • Apply soothing lotions such as calamine lotion, aloe vera gel, over the counter steroid cream, etc.
  • Treat, prevent ingrown hair by removing the curved in hair with tweezers carefully, allowing the hair to grow long, etc.
  • Treat the underlying infection causing low immunity.

 

Recurring, persisting bumps, boils/furuncles, carbuncle can be treated by a course of oral antibiotic medications, medicated shampoos or antifungal creams and medications for fungal infection, drainage of pus with instruments (minor procedure) by the doctor for better and faster healing.

Prevention:

  • Avoid frequent shaving, waxing.
  • Shave in the direction of hair growth after washing the area with water (to remove ingrown hair), followed by an after shave (antiseptic) application.
  • Prefer trimmer, electric razors, laser hair removal.
  • Avoid use of public hot pools or pools with poor maintenance, poor hygiene.
  • Take bath regularly in a day, especially after exercises, excessive sweating.
  • Wash hands always after touching an infected material, surface and before touching any part of body.
  • Take prescribed medications for the treatment of an underlying infection at the earliest.
  • Do not share personal items such as napkins, shaving kit, etc. with others.
  • Avoid use of products with irritants, harsh chemicals.

References:

https://www.mayoclinic.org/diseases-conditions/folliculitis/symptoms-causes/syc-20361634

http://www.dermatologist.org.uk/folliculitis.html

https://www.nhs.uk/conditions/ingrown-hairs/

https://www.uofmhealth.org/health-library/hw171614

http://www.pcds.org.uk/clinical-guidance/folliculitis-an-overview

http://www.bad.org.uk/ResourceListing_NonResponsive.aspx?id=451&showmore=1&sitesectionid=159&group=00016001000200010003&range=K-O#.Wv5imi-B2Rs

https://www.aad.org/public/diseases/bumps-and-growths/folliculitis

http://www.aocd.org/?page=Folliculitis

 – Dr. Divya Teja Pasupuleti

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