Q. I am told I have folliculitis on my skin. What exactly is that and how do I get rid of it?
A. First off, let’s explain the term folliculitis. For many words that end in “itis”, it is a sign that the area in question has some swelling or inflammation. Folliculitis is no exception and, therefore, it is best described as an inflammation of a follicle.
What is a follicle? Well, our body has hair all over our skin with some areas being obvious, such as the head, and others less so with hair so fine you may not notice it is there. The function of our body hair, beyond adding to our appearance, is it helps keep us warm. Our hair enters the skin, and thus how it is attached, by way of a follicle. When this area of the skin gets disturbed, it may allow microscopic offending agents to enter the skin and disrupt the peace. Your body will likely try to overcome this invasion and become swollen/inflamed and possible infected. This is termed folliculitis.
It can appear just about anywhere we have hair, but the most common areas are the face, scalp, arms, upper back and lower legs. The surrounding skin may be itchy, red, tender and/or painful and may have one or several small bumps that may appear as pimples or acne. Often, the folliculitis may be mild in nature and resolve on its own without seeking medical attention. It is also possible for the pus-filled sacs to break and crust over. Some cases of folliculitis are more severe and the infection may spread and perhaps get out of control requiring a visit with a health care professional. Sometimes a stronger topical prescription or an oral antibiotic is warranted.
There are various types of folliculitis depending on the area and whether the offending agent is bacterial, fungal, or viral depending on the root cause. Here is a listing of the various types and a few key facts on each.
- Staphylococcus aureus folliculitis:
– Caused by the bacteria called staphylococcus aureus
– Most common type of folliculitis
– Appears as red or white pus-filled pimples
– May be itchy
– Often resolves on its own in a few days
- Pseudomonas aeruginosa (“hot tub”) folliculitis:
– Caused by bacteria called pseudomonas aeruginosa
– Thrives in heated water that is moving such as hot tubs, whirlpools, water slides
– Appears as red or white pus-filled pimples that are worse in areas where the bathing suit traps the water on your skin
– Occurs 1 to 2 days after exposure
– Often resolves on its own in a few days
- Malassezia folliculitis:
– Caused by fungi in the yeast family called Malassezia
– Appears as an acne-like rash
– Often itchy
– Usually found on upper chest and back
– Worsened by sweat
– Helped by using anti-dandruff shampoo every day to wash affected area
- Pseudofolliculitis barbea:
– Also termed razor bumps due to shaving
– Most common in people with curly hair (curly hair is more apt to turn back into the skin causing ingrown hairs)
– Most commonly found on the bearded area of face but can also be found in genital area or any other shaved areas
– To help reduce the severity of this type
> try to shave or use trimmers every other day or even less often
> soften the hair with hot water before shaving
> use a shaving gel or cream
> shave with the grain of the hair and not against it
> use an electric razor as opposed to a razor blade
>avoid pulling the skin while shaving
– may lead to scarring so a consultation with a dermatologist may be warranted
- Sycosis barbae:
– Severe form of shaving folliculitis
– Entire hair follicle becomes infected as opposed to only a portion of the follicle closest to the outer skin
– Large red pustules form
– Avoid shaving to prevent further issues and consult a dermatologist
- Gram-negative folliculitis:
– Results from resistant bacteria growth often from long-term antibiotic use as in the treatment of acne
– This may further worsen the acne
– Requires a consult with a dermatologist
- Boils (furuncles):
– Deeply infected hair follicle
– Red, tender, painful
– May come to a head in few days
– May be scarring
– May need antibiotics or a medical procedure to remove the build-up of pus in order to for it to alleviate
– A group of several boils
– Involves multiple infected hair follicles
– May need antibiotics or a procedure as in the case of boils
- Eosinophilic folliculitis:
– Often due to immunosuppression
– Not infectious
– Itchy pustules
– Mostly found on shoulders, upper arms, neck and forehead
– May resolve on its own
As you can see with the list above, some risk factors that can cause folliculitis are shaving, using oral antibiotics long-term, performing activities that encourage sweating, using hot tubs or saunas that are not well maintained. Keep it mind that both bacteria and fungi are naturally on our skin and usually coexist nicely. These offending agents only become a problem when they enter the body through an open sore.
Carrying extra weight increases our risk of folliculitis and the extra weight may lead to “folds” on our body which also add to the risk by increasing sweat and trapping hair. Diabetes also increases your risk and the higher blood sugars may impede the healing. Adhering to a healthy lifestyle with proper eating habits and an exercise routine can minimize these two risk factors.
How you treat folliculitis depends upon which one of the above types you have. As mentioned above, some may resolve on their own while others may need the help of a healthcare provider. Treatment depends upon whether the offending agent is bacterial or fungal, as an anti-fungal will not help resolve a bacterial infection and vice versa. In either case, you will want to cleanse the area to keep the surrounding skin to free from further contaminants.
Using warm towels as a compress can help soothe the skin. For mild bacterial folliculitis, a topical antibiotic lotion or gel should treat the infection. For more severe bacterial infections, an oral antibiotic might be warranted. For fungal folliculitis, there are creams, shampoos and oral medications that can help treat the infection. If you are unsure what type of folliculitis you have, it might be a good idea to speak to a healthcare professional to help confirm which type of folliculitis it might be. Since this is a condition that has swelling and possibly pain or discomfort, using medication to help reduce inflammation, whether it be topical or oral, may prove useful. Also, if itching is a concern for you, applying a steroid cream can help relieve that.
As is the case with many conditions, prevention is key. Since most folliculitis infections involve bacteria or fungi entering the skin at the hair follicles, one of the most crucial habits to adhere to is to keep your skin clean.
Also, if you love to soak in a hot tub or whirlpool, ensure it has been properly disinfected before you hop in. Another great habit to get into is to rinse your body and your swimsuit as soon as you get out of the water. Your clothing choice can play a role as well since some materials are not breathable and may increase sweating and trap it against your skin. To reduce this build-up of yeast against your skin which increases your risk of folliculitis, choose clothing materials that are more breathable.
For more information on this or any other health related topic, contact your pharmacist.