Folliculitis: When You Shouldn’t Ignore Those Red Bumps

If you’ve noticed strange red bumps or pimple-like spots on your skin, don’t ignore them! Odd rashes, itching, and widespread “acne” can be the first indications that you have folliculitis. This is a common skin condition and one that your dermatologist can help you fight successfully. If caught early, there are no permanent side-effects, so always check with your dermatologist about any strange skin conditions.

What is Folliculitis

This skin condition is caused by hair follicles (the space in your skin that holds the hair root and oil glands) that become inflamed. Usually a result of a bacterial or fungal infection, folliculitis usually first appears as small red bumps or pimples with whiteheads. The clusters then spread and can start developing into crusty, pus-oozing sores. Common symptoms include:

• Soreness

• Itching

• Swelling

• Pus

• Hair loss (not permanent unless there is damage to hair follicles in severe cases) 

There are numerous types of folliculitis, as the form can change based on what caused it, how you got it, and how far it has progressed. The most common include:

• Staphylococcus aureus folliculitis (small red or white pus-filled pimples caused by the staphylococcus aureus bacteria. It can be cared for at home and usually resolves quickly.)

• Pseudomonas aeruginosa “hot tub” folliculitis (this bacteria lives in heated, moving water. It causes similar symptoms as the Staph version, but tends to itch.)

• Malassezia folliculitis (family of yeast that is normally on the skin, but when it gets into the follicles, it causes itchy acne breakouts.)

• Pseudofolliculitis barbae “razor bumps” (usually occurs in the beard area when short hair turns back into the skin)

• Sycosis barbae (severe, potentially scarring form that results in large, red pustules)

• Gram-negative folliculitis (occurs after prolonged antibiotic use for acne. Resistant bacteria grow and multiply, worsening the acne.)

• Boils or furuncles (occur when the hair follicle becomes deeply infected. May result in scarring.)

• Carbuncles (several boils in one spot)

• Eosinophilic folliculitis (immunosuppressed version sometimes seen in babies. Characterized by itchy pustules and not infectious.)

Causes and Risk Factors

Infection of the hair follicle is most often caused by Staphylococcus aureus (staph) bacteria. Folliculitis can also result from viruses, fungi, and inflammation from ingrown hair.

Anyone can develop this skin condition, but there are certain factors that increase your susceptibility, including:

• Medical conditions that compromise your immune system (chronic illnesses, autoimmune disorders, etc.)

• Acne, dermatitis, and other conditions that jeopardize the skin barrier

• Certain medications like steroid creams or long-term antibiotic therapy

• Shaving, especially if you have curly hair

• Regularly wearing clothing that traps heat and sweat against your skin

• Soaking in improperly maintained hot tubs

• Damage to follicles through shaving, waxing, tight clothing, etc

Complications That May Occur

Left untreated, folliculitis will continue to spread and worsen. Our immune systems are equipped to deal with infections like these quickly, but if your immunity is overwhelmed or compromised, the infection will take over without intervention.

Depending on the type of folliculitis and where it has formed, possible complications include:

• Recurrent and spreading infection

• Boils under the skin (furunculosis)

• Permanent skin damage, scarring, and dark spots

• Destruction of hair follicles and permanent hair loss

Diagnosis and Treatment

If you notice any of the above symptoms related to folliculitis, contact your dermatologist. It can be tempting to ignore the red spots, pimples, itching, and even soreness. However, the earlier it is diagnosed and treatment begins, the sooner you will be able to heal and move on without permanent side effects. Some forms can be treated with home remedies, but severe cases may need medication.

Your dermatologist will look at your skin and ask you questions about your symptoms and medical history. A microscopic examination (dermoscopy) is the simplest way to determine if you have folliculitis. Your doctor may send a swab of the infected skin and hair to a lab or, in rare cases, order a skin biopsy to rule out other conditions.

Treatment depends on the type of folliculitis and its severity. But usually some form of topical cream or antibiotic pill will be used to kill the bacteria. Laser hair removal can help prevent a spread of the infection. Infections may die down and return later, so have a conversation with your dermatologist about the best ways to fight this infection.

Antifungal medications are used for fungal infections and antibiotics for bacteria. Various creams and pills are also used to reduce the inflammation and discomfort. For boils, minor surgery could be necessary.

If you ever notice strange outbreaks of acne-like spots or lingering skin/hair discomfort, contact one of our offices. Our team is here for you and we are always ready to answer your questions. Folliculitis does not have to be an embarrassing or difficult issue. It is possible to have healthy skin again.