Folliculitis on the Vulva: Causes, Symptoms, and Treatment

Folliculitis is a common skin condition characterized by inflammation of hair follicles. While it can occur anywhere on the body, including the vulva, or genital area, it may be a bit painful, and prompt attention is important to prevent potential complications. Every piece of content at Flo Health adheres to the highest editorial standards for language, style, and medical accuracy.

What is Folliculitis?

Folliculitis is a skin condition that occurs when hair follicles become inflamed or infected. This can happen due to various reasons, including bacterial, fungal, or viral infections, as well as blockages or irritation of the follicles. Folliculitis can manifest as small pimples, crusty sores, or larger areas of swollen skin.

Causes of Genital Folliculitis

Folliculitis, even in the genital region, is generally not contagious. However, due to the proximity of hair follicles to one another in the vaginal region, the infection can spread from one to the next, eventually looking like a patch of acne. Folliculitis happens when your hair follicles are damaged. When they’re damaged, it’s easy for germs to get inside the follicles and cause an infection. The infection can be caused by bacteria, usually by Staphylococcus aureus (staph), viruses, or fungi.

Several factors can contribute to the development of folliculitis on the vulva:

Hair Removal: Shaving, waxing, or plucking pubic hair can irritate hair follicles, making them susceptible to infection. The initially infected follicle may occur as a result of an ingrown hair, caused by a follicle blocked by sweat and dead skin cells. Genital folliculitis is more common in areas of the body where hair is rough and often shaved, including the vaginal region.
Tight Clothing: Tight clothing and elastic underwear bands can cause excess friction; that, coupled with sweat from vigorous exercise or even just continuous walking creates an environment that is ideal for folliculitis to occur. Tight clothing can slough off dead skin cells, and then sweat and oils in that area become trapped in the hair follicles.
Poor Hygiene: Inadequate hygiene practices can lead to a buildup of bacteria and dead skin cells, increasing the risk of follicle infection.
Irritants: The sensitive skin of the inner thighs and vaginal region is especially susceptible to irritation, for example, from tight clothing against the skin or from a partner who has recently shaved. Skin is especially susceptible after shaving.
Contaminated Water: Dirty hot tubs and spas can also cause folliculitis, as bacteria thrive in inadequately chlorinated warm water.

Types of Vulvar Folliculitis

Folliculitis can manifest in different forms, including:

Irritant Folliculitis: Redness, chafed skin, and itchiness is commonly referred to as “razor burn” and occurs within 36 hours of shaving. The injured follicles are highly susceptible to becoming infected. To clear your skin more quickly and get relief, you can try applying warm compresses to the area. You can also try to relieve itchy skin with a soothing lotion.
Razor Bumps (Pseudofolliculitis Barbae): Razor bumps are the result of an inflammatory reaction surrounding ingrown hairs. They can occur on any part of your body where hair is shaved. New hairs that grow back after removal may become trapped beneath the top layer of skin and curl backward. As the hair grows, the layers of your skin become irritated and can become infected. You can remove ingrown hairs with sterilized tweezers or seek a professional dermatologist or aesthetician certified in genital hair removal.
Hot Tub Folliculitis (Pseudomonas Folliculitis): This shows up as a rash of red, round, itchy bumps.

Symptoms of Genital Folliculitis

Vaginal folliculitis looks like a pimple on the inner thighs, labia, or pubic mound area. You can tell the difference between an acne pimple and vaginal folliculitis by looking for a hair. If there’s a hair in the middle of the bump, it’s genital folliculitis or an infected hair follicle. If there’s no hair in the middle, then it’s probably vaginal acne. If you aren’t sure, visit your OB-GYN or dermatologist for a diagnosis.

Folliculitis, unlike genital acne, is typically painless, although the bumps may be red or sore. There are also sometimes symptoms of infection associated with folliculitis such as itching, crusty sores, and low fever. Folliculitis looks like a mosquito bite or raised bump. Common signs and symptoms include:

Small, red bumps or whiteheads around hair follicles
Itching or soreness
Pus-filled blisters
Large, painful lumps
Swollen skin

Potential Complications

If left untreated, folliculitis can sometimes grow into boils or carbuncles. These are larger infections under the skin, full of pus, that can turn into abscesses. The risk of infection is higher the larger the boil is, and they should be treated in a sterile medical setting. While these may heal on their own, people with a compromised immune system may end up with a severe infection.

Permanent hair loss is a rare side effect. Treatment for folliculitis includes medications and, in some cases, laser hair removal. Even if it helps, the infection may come back.

Treatment Options

You need to be careful about treating folliculitis in the vaginal region to prevent transferring the infection and scarring. You can treat mild cases involving just a few infected hair follicles by using a warm compress to loosen the infection and allowing the skin to heal. If the infection was caused by shaving, plucking, or waxing, it’s best to skip those treatments for 30 days. Medications for genital folliculitis:

Creams or pills to control infection: Your health care provider may prescribe an antibiotic cream for mild cases. Oral antibiotics may be prescribed for a severe or recurrent infection.
Creams, shampoos, or pills for fungal infections: Antifungals are for infections caused by yeast rather than bacteria. Antibiotics aren’t helpful in treating this type of infection.
Minor surgery: If you have a large boil or carbuncle, your health care provider may make a small incision in it to drain the pus to relieve pain and speed recovery.
Laser hair removal: This method permanently removes hair follicles in the treated area.

Treatment for folliculitis depends on the type and severity of the infection. Mild cases often resolve on their own with proper hygiene and home care. However, more severe or persistent infections may require medical intervention.

Topical Antibiotics: For mild bacterial infections, a healthcare provider may prescribe an antibiotic cream or ointment to apply to the affected area.
Oral Antibiotics: In cases of severe or recurrent bacterial folliculitis, oral antibiotics may be necessary to clear the infection.
Antifungal Medications: If the folliculitis is caused by a fungal infection, antifungal creams, shampoos, or oral medications may be prescribed.
Minor Surgery: Large boils or carbuncles may require drainage by a healthcare provider to relieve pain and promote healing.
Laser Hair Removal: For recurrent folliculitis caused by ingrown hairs, laser hair removal may be recommended to permanently remove the hair follicles.

Prevention Strategies

Preventing infected hair follicles in the pubic region includes practicing proper hygiene, including regular washing with warm water. Do not share towels, and change your washcloth often to prevent bacteria buildup. It’s especially important to practice good vaginal hygiene during your period. Not only do hormonal shifts cause the skin to be more sensitive, but there’s also a higher population of bacteria that can infect hair follicles and chafed skin.

Use an exfoliant recommended by your dermatologist. Do not use facial products on your vulva unless prescribed. If you choose to shave, use a sharp, clean razor and change it frequently, or switch to an electric razor. Shave in the direction of the follicle, not against it. Make sure not to stretch the skin. You can also consider alternative hair removal methods such as waxing, depilatories, or laser hair removal. These procedures remove the entire hair from the root. When the hairs grow back, they’re typically finer, with a smooth tip instead of the blunt, rough tip that shaved hairs have, reducing instances of ingrown hairs.

To prevent folliculitis on the vulva, consider the following measures:

Practice Good Hygiene: Wash the genital area regularly with mild soap and warm water, especially after sweating or physical activity.
Avoid Tight Clothing: Wear loose-fitting clothing and breathable underwear to reduce friction and moisture buildup.
Use Proper Shaving Techniques: If shaving, use a clean, sharp razor and shave in the direction of hair growth. Avoid stretching the skin or pressing too hard.
Exfoliate Regularly: Gently exfoliate the skin to remove dead cells and prevent ingrown hairs.
Avoid Irritants: Refrain from using harsh soaps, detergents, or feminine hygiene products that can irritate the skin.
Clean Hot Tubs: Ensure that hot tubs and spas are properly cleaned and chlorinated to prevent bacterial growth.
Change your habits: Stop doing whatever may have inflamed your hair follicles. For instance, you may need to stop plucking, using a hot tub, or wearing your favorite leggings for a while.
Try not to scratch: Although the area may be itchy, scratching could open up the follicle and either cause or worsen an infection.
Don’t squeeze, pop, or cut open bumps: This can spread infection.

When to Seek Medical Attention

Genital folliculitis is generally mild and easily preventable with proper hygiene and care. However, it’s important to note that certain sexually transmitted infections (STIs) can look very similar to a folliculitis bump or vaginal acne.

While most cases of folliculitis on the vulva are mild and self-limiting, it's essential to seek medical attention if:

The infection spreads or worsens
Symptoms persist for more than a few days
You develop a fever or feel unwell
You have large, painful boils or carbuncles
You have a weakened immune system

Differential Diagnosis

Folliculitis may look like other skin conditions, including acne, insect bites, or impetigo. If home treatments aren’t helping your symptoms, your doctor may be able to tell if something else is causing them.

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