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Folliculitis

Folliculitis is a skin condition where the hair follicles become inflamed and infected. Most of the time it's caused by the bacteria, Staphylococcus aureus.

  1. Often due to follicles becoming damaged from friction
  2. Can occur anywhere on the body where hair grows
  3. Treated with topical creams or antibiotics depending on severity

Book an appointment through our video doctor service if you would like to get advice about folliculitis online. We work with GMC-registered practitioners who can prescribe treatment or refer you to a specialist where required. 

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Description

What is folliculitis?

Folliculitis is a skin condition that stems from a disruption in the pilosebaceous glands, which deposit sebum in the hair to lubricate it. This can lead to the formation of boils, which are rooted in the base of the follicle and contain pus. It is a very common condition, and is usually caused by the bacteria, Staphylococcus aureus. Less commonly, a fungal infection may be the cause.

In most cases, it's a fairly superficial condition that will clear reasonably quickly, although it can become persistent and develop into a long-term problem.

Folliculitis has the appearance of a normal rash, with the addition of bumps that become pus-filled when follicles are infected.

What types of folliculitis are there?

There are three main types of folliculitis: sycosis barbae, hot tub folliculitis and gram-negative folliculitis. 

Sycosis barbae is folliculitis that affects the beard, and can makes the skin painful and crusty. Hot tub folliculitis develops from contact with bacteria growing in hot water that hasn’t been properly chlorinated. Gram-negative folliculitis can occur as a complication of another skin condition, such as acne.

There is also a condition called pseudo-folliculitis, which looks similar; however, it is caused by ingrown hairs and not a bacterial infection. This is very common in people with curly hair, and is not a serious condition, but it can cause some discomfort.

The bacteria that cause folliculitis live on the surface of the skin harmlessly in most people. However, it’s when the bacteria gets into a break or opening in the skin (such as a hair follicle) that an infection may develop. 

Who gets folliculitis?

Risk factors for folliculitis include: excessive sweating, shaving against the grain of the hair, wearing tight fitting clothing against hairy areas of the body and high humidity. 

In most cases, folliculitis will respond to medication and not require further treatment. However, complications are possible. The most common of these is persistent bouts of folliculitis. Scarring is another potential complication, but is less prevalent. 

In very rare cases, the infection can progress into a more serious one, affecting deeper layers of tissue. 

It’s easy to speak to a doctor online about folliculitis with our private video service. We work with GMC-registered doctors in the UK, who will be able to give you advice and prescribe treatment where appropriate. Book a slot at a time most suitable for you. 

Page last reviewed:  12/06/2020
Diagnosis and treatment

How is folliculitis diagnosed?

Folliculitis can be diagnosed from a simple examination by a doctor. It initially forms as a rash, before developing into red lumps on hairy areas of the skin. These lumps may also contain pustules, and are commonly found on the face, beard, scalp and thighs. It can be painful and irritating, which leads to a desire to scratch; however, this should be avoided as it can cause scarring.

Will I need tests?

You will not usually need tests for folliculitis. A diagnosis can often be made based on a visual examination. A doctor may use a magnifying glass to see areas of skin that are covered with a lot of hair. If following initial treatment the symptoms have not cleared, a doctor may decide to take a sample of hair for examination in a laboratory, in order to determine the cause of the infection.

What will a doctor normally advise?

To help prevent folliculitis, a doctor will advise keeping your skin in good condition, ensuring it is kept dry and not rubbing against tight clothing or irritating material. They will also advise keeping the skin moisturised and ensuring that the face is properly lubricated when shaving for men. 

For mild cases of folliculitis, a doctor may suggest using an emollient such as Dermol to improve the skin’s condition and allow it to heal by itself. For more localised and severe infections, treatment may be advised.

What treatments are there for folliculitis?

It depends on the severity of the infection, and what is thought to be causing it. A minor case of folliculitis can be treated by using a skin emollient, and keeping the area dry and away from potential irritants. More severe cases may require an antibacterial cream to reduce inflammation, or even antibiotics, if the infection is widespread.

Fusidic acid is a topical antibiotic used to treat folliculitis caused by a bacterial infection, and may be recommended by a doctor, while flucloxacillin and erythromycin are oral antibiotics that a doctor may advise you to use.

An antifungal might be prescribed if a fungal infection is suspected to be the cause.

Page last reviewed:  12/06/2020
Questions and Answers

How is folliculitis treated?

It doesn’t always need treatment. If symptoms are uncomfortable or severe, however, medication may be advised.

Mild folliculitis can be treated with an emollient cream to keep the skin in good condition and reduce irritation.

Prescription antibiotics or antibiotic cream may be recommended in more severe cases.

What treatments are there?

Dermol is an example of an emollient used in mild folliculitis. It works by softening the skin and keeping it moisturised, providing relief from irritation.

Fusidic acid is a topical antibiotic cream used to treat folliculitis. Oral antibiotics are also used, such as erythromycin and flucloxacillin.

It isn’t common for folliculitis to be caused by a fungal infection, but in the event that it is, an antifungal cream such as clotrimazole may be recommended.

Are there side effects?

Fusidic acid can lead to an allergic reaction where the cream is applied, but this is very rare. Common side effects from taking flucloxacillin include nausea, vomiting, diarrhoea and bloating. It should be noted that these side effects are common amongst many antibiotics, however. Topical lotions can irritate the scalp and result in hair growth on unwanted areas of the skin.

Can I consult a doctor about alopecia online?

Yes. If you are experiencing hair loss and are concerned about alopecia spreading, you can book an appointment with one of doctors using our online video consultation service, at a time that's best for you. 

Page last reviewed:  12/06/2020

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