Folliculitis: Causes, Symptoms, and Treatments, Including the Use of Lotions

Folliculitis is a common skin condition characterized by inflammation of hair follicles. This can occur anywhere on the body where hair grows, including the face, arms, upper back, and lower legs. While often mild and self-limiting, folliculitis can sometimes become severe, leading to discomfort, pain, and potential complications.

Understanding Folliculitis

Folliculitis arises when hair follicles become infected or inflamed. The etiology of folliculitis is often unclear, but perspiration, trauma, friction, and occlusion of the skin are known to potentiate infection. The primary skin finding in folliculitis is a pustule and perifollicular inflammation. The condition can be caused by bacteria, fungi, viruses, or even ingrown hairs. Identifying the specific cause is crucial for effective treatment.

Symptoms and Signs of Folliculitis

Symptoms of folliculitis are mild pain, pruritus, or irritation. Signs of folliculitis are a superficial pustule or inflammatory nodule surrounding a hair follicle. Infected hairs easily fall out or are removed by the patient, but new papules tend to develop. Growth of stiff hairs into the skin may cause chronic low-grade irritation or inflammation that may mimic infectious folliculitis (pseudofolliculitis barbae).

Folliculitis can manifest in various ways, with common symptoms including:

• Itchiness
• Soreness or tenderness
• Burning or stinging
• Rough, dry, or flaking skin
• The hair follicle may get inflamed and appear red and bumpy

The appearance can range from small, red bumps resembling acne to pus-filled blisters. In more severe cases, folliculitis can present as boils or carbuncles.

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Types of Folliculitis

There are many different types of folliculitis - each one unique based on the cause, the infectious organism and its impact on the skin. Often, the thing that causes the condition is one of the biggest factors that sets each type of folliculitis apart. Location can also play a role - where you experience this condition on your body can change depending on what type of folliculitis you have. Several types of folliculitis exist, each with its own causes and characteristics:

• Bacterial Folliculitis: Usually caused by Staphylococcus aureus, this type presents as small, red or white pus-filled pimples. Treatment with topical mupirocin or topical clindamycin is generally effective.
• Hot Tub Folliculitis (Pseudomonas aeruginosa): This occurs due to inadequate chemical treatment of water in hot tubs, leading to infection by Pseudomonas aeruginosa. Hot tub folliculitis occurs one to two days after exposure to the water source and typically fades on its own within a few days.
• Malassezia Folliculitis: Caused by Malassezia yeast, this itchy condition resembles acne and typically affects the upper chest and back. Using an antidandruff shampoo every day to wash the affected areas of skin is often helpful.
• Pseudofolliculitis Barbae (Razor Bumps): Common in the beard area, this occurs when shaved hairs curl back into the skin, causing irritation. Avoidance of shaving or using trimmers can help.
• Sycosis Barbae: A severe form of shaving-related folliculitis where the entire hair follicle is infected, resulting in large red pustules. Shaving should be avoided and you should see a dermatologist for discussion of treatment options.
• Gram-Negative Folliculitis: Can occur after prolonged antibiotic use for acne, leading to the growth of resistant bacteria. This condition requires treatment from a dermatologist or another healthcare provider.
• Boils (Furuncles): Deep infections of the hair follicle that are red, tender, and painful. In certain cases, oral medications or procedures are needed to resolve the lesion.
• Carbuncles: Clusters of boils that form a larger, more severe infection. As with boils, in certain cases, oral medications or procedures are needed to resolve the lesion.
• Eosinophilic Folliculitis: Typically seen in immunosuppressed individuals, characterized by itchy pustules on the shoulders, upper arms, neck, and forehead. They often resolve on their own, but can come back (recur).

Diagnosis of Folliculitis

Clinical evaluation is usually sufficient for diagnosis. The primary skin finding in folliculitis is a pustule and perifollicular inflammation. Microbiologic testing is not routinely indicated. However, if the condition is persistent or unresponsive to initial treatment, further investigation may be necessary.

If these measures do not result in a cure, or folliculitis recurs, pustules are Gram stained and cultured to rule out gram-negative or methicillin-resistant S. aureus (MRSA) etiology, and nares are cultured to rule out nasal staphylococcal carriage. Potassium hydroxide wet mount should be done on a plucked hair to rule out fungal folliculitis.

Treatment Options for Folliculitis

Treatments for folliculitis depend on the type and severity of your condition, what self-care measures you've already tried, and how you'd like to proceed. Treatment strategies vary depending on the type and severity of the infection.

Topical Treatments

• Antibiotic Lotions and Creams: For mild bacterial folliculitis, topical mupirocin or clindamycin is generally effective. Over-the-counter antibiotic creams, gels, and ointments may help clear up a small patch of folliculitis. Apply the cream with a new, clean cotton swab.
• Benzoyl Peroxide Wash: A 5% benzoyl peroxide wash can be used for 5 to 7 days when showering.
• Antifungal Creams and Shampoos: These are used for infections caused by yeast rather than bacteria. Antibiotics aren't helpful in treating this type of folliculitis. Using an antidandruff shampoo every day to wash the affected areas of skin is often helpful.
• Anti-Itching Lotions and Creams: Over-the-counter anti-itching lotions and creams can help soothe folliculitis symptoms. They contain hydrocortisone, a kind of steroid medication that helps bring down itching, swelling, and redness. Apply the steroid cream or lotion thinly over the skin area. Wash your hands after using it. Hydrocortisone cream is a medication, so use it only as directed.

Systemic Treatments

• Oral Antibiotics: Extensive cutaneous involvement may warrant systemic therapy (eg, cephalexin 250 to 500 mg orally 3 to 4 times a day for 10 days). Infection-fighting pills (oral antibiotics) aren't routinely used for folliculitis, but you may need them for a severe or repeat infection.
• Oral Antifungals: For severe fungal infections, oral medications may be prescribed.

Other Treatments

• Minor Surgery: If you have a large boil or carbuncle, your health care provider may make a small cut in it to drain the pus. This may relieve pain, speed recovery and lower the risk of scarring. Your health care provider may then cover the area with sterile gauze to absorb any leaking pus.
• Laser Hair Removal: Your health care provider may suggest laser hair removal as an option for pseudofolliculitis barbae, especially when other treatments haven't improved your symptoms. This treatment often requires multiple visits to the health care provider's office. Talk with your health care provider about possible side effects of laser treatment. They include scarring and skin that lightens (hypopigmentation) or darkens (hyperpigmentation).

Home Remedies

In addition to medical treatments, several home remedies can help alleviate symptoms and promote healing:

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1. Soap Wash: Clean the area with warm water and soap twice a day. Dry off with a clean towel and avoid sharing your towel with anyone. Also, use hot water and detergent to wash any clothing or towels that have touched the folliculitis.
2. Warm Compress: A warm, moist compress can help soothe soreness, swelling, and pain. Use a new or sterilized washcloth. Boil a soft cotton cloth or launder it in warm water and soap to make sure it’s clean. Boil 2 to 3 cups of water. Let the water cool until it’s warm or at room temperature. Add 1 teaspoon of table salt and stir. Soak the compress in the salt solution. Squeeze out extra water. Gently press the washcloth onto your skin. Repeat several times a day, using a clean washcloth each time.
3. Hydrogen Peroxide Wash: You can find hydrogen peroxide in the first aid aisle of your local pharmacy. Hydrogen peroxide can help get rid of some bacteria and fungi that cause folliculitis. Dilute the hydrogen peroxide with clean, sterile water or use it directly. Apply it onto your skin with a cotton swab. You can use a small spray bottle for larger areas. Let the area dry and reapply as needed. Avoid using hydrogen peroxide on areas of healthy skin - you don’t want to kill “good” bacteria on the skin. Some bacteria help get rid of germs that cause infections like folliculitis.
4. Wet Wraps: Wet wrap therapy is a way to help ease skin itching and irritation. Dermatologists recommend this at-home therapy for people who have eczema and other skin rashes. It can also be used to help reduce folliculitis symptoms like itchiness. Not scratching itchy skin can help speed up healing. It may also help prevent folliculitis from getting worse or spreading to other body areas. You can use antibiotic ointment or anti-itching lotion first. Wash the area and your hands with warm soapy water. Cut a clean cotton cloth into strips or use gauze bandages - the type used to dress cuts. Pour sterile water (or boiled water that has been cooled) into a bowl. Soak a cotton or gauze strip in the water. Squeeze out the water and lay over your area. Repeat until the entire area of folliculitis is covered. Cover the wet bandages with dry ones. Leave on for up to 8 hours. Remove the bandages and use fresh cloth or gauze if you want to reapply the wet wrap.
5. Aloe Vera: Aloe vera gel may help heal the skin faster. It’s also cooling, which may help soothe itching, redness, and swelling. Research shows that aloe vera gel may also help stop some kinds of infection-causing bacteria. Look for pure aloe vera gel with no added perfumes and other chemicals. Apply aloe vera gel on the skin after cleaning the area with soap and water.
6. Loose, Dry Clothing: Folliculitis can sometimes happen from wearing clothing that irritates the skin or when skin rubs against skin. Avoid wearing clothing like yoga pants, tights, leggings, and other tight clothing. Also, avoid wearing outfits that allow your thighs to rub against each other. Wear shorts under a dress or skirt. Wear longer sleeve T-shirts and dresses to cover the skin under your arms. Wet skin is also more likely to get an infection. Wear loose and breathable or moisture-wicking fabrics. Dry off and change right away if you’re sweaty or wearing wet clothing.
7. Essential Oils: Medical studies show that some essential oils have antibacterial and antifungal properties. Some essential oils may work against bacteria and fungi that cause folliculitis. Essential oils shouldn’t go directly on your skin. Dilute the essential oil by adding a few drops to a carrier oil or a moisturizing cream. Essential oils are powerful, so using them directly or too much can irritate your skin. Essential oils that may help treat skin infections like folliculitis include: cinnamon oil, lemon oil, clove oil, tea tree oil, chamomile oil, eucalyptus oil. Avoid essential oils if you’re pregnant or breastfeeding. They may not be safe for babies. While research suggests there are health benefits, the FDA doesn’t monitor or regulate the purity or quality of essential oils. It’s important to talk with your healthcare provider before you begin using essential oils and be sure to research the quality of a brand’s products. Always do a patch test before trying a new essential oil.
8. Avoid Shaving and Waxing: Some kinds of folliculitis, like barber’s itch, happen after shaving the skin. This can happen when shaving the face, head, or body. Shaving may irritate the skin and open up the hair follicles. This raises the risk of infection. Avoid shaving until the folliculitis has cleared up. When you do shave, use clean, sharp blades each time. Clean the area with warm, soapy water before and after shaving. Some kinds of hair removal like waxing can open up the hair follicle too much. This can lead to ingrown hair and skin infections like folliculitis. Avoid waxing the area where you have folliculitis. Try other kinds of hair removal methods like depilatory creams instead.

Lotions for Folliculitis

Folliculitis creams and targeted treatments for ingrown hairs are the ideal solution for smooth and blemish-free skin after hair removal. Formulated with soothing and purifying ingredients, these products help reduce redness, inflammation, and skin discomfort caused by folliculitis.

Folliculitis creams for legs and ingrown hair creams for the bikini area are designed to gently treat even the most sensitive areas. Ideal for use after hair removal, these formulas work to gently exfoliate, unclog pores, and calm irritated skin.

Treatments like ingrown hair creams for hair removal and creams for folliculitis and ingrown hairs are essential in any skincare routine. When used consistently, they not only soothe and hydrate the skin but also help prevent skin imperfections, leaving it visibly smoother and healthier.

Prevention of Folliculitis

Several measures can be taken to prevent folliculitis:

• Proper Hygiene: Regularly wash skin with mild soap and water.
• Avoid Tight Clothing: Wear loose, breathable clothing to reduce friction and irritation.
• Shaving Precautions: If shaving, use a clean, sharp razor and shave in the direction of hair growth.
• Hot Tub Hygiene: Ensure hot tubs are properly chlorinated and maintained.
• Avoid Irritants: Minimize exposure to oils, greases, and other substances that can clog hair follicles.
• Dry off and change right away if you’re sweaty or wearing wet clothing.

When to Seek Medical Attention

Folliculitis usually goes away by itself without treatment. Home remedies can help soothe symptoms like itching, tenderness, and redness. They can also help prevent folliculitis from happening or getting worse.

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Some kinds of folliculitis are more serious. They cause a severe skin infection that leads to hair loss or scarring. See your doctor if you have any signs of a serious infection.

It is important to consult a healthcare professional if:

• Symptoms are severe or worsening
• The infection is spreading
• Home remedies are ineffective
• You experience a fever or other signs of systemic illness
• You have any signs and symptoms of severe folliculitis, such as: whitehead pimples around the hair follicles; pus or oozing from the skin; crusty sores on the skin; swelling; a large bump or mass; hair loss; scarring.
• See your doctor or dermatologist if you’ve used hydrocortisone cream for 2 weeks or longer and still have skin itching.

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