Folliculitis is a form of condition on the skin where the hair follicles, a tiny area in the skin where the oil glands and roots of the hair are placed, are inflamed and is mainly brought by infection from fungi or bacteria. Initially, it would appear as tiny red or white lumps that grow around the hair follicles. It grows in common places in the body where rubbing frequently occurs like armpits, neck, thighs, and buttocks. When hair follicles are irritated, it would start showing redness, becomes very itchy and establishes lumps around the hair follicles. You may mistake it for acne or rashes as it may look like them. It can either be chronic or acute folliculitis but is nothing serious and can heal by itself.
There are two types of folliculitis; superficial and deep folliculitis. Superficial folliculitis only affects a part of the follicle while the deep folliculitis is more serious than the superficial because it affects the whole follicle.
Types of Superficial Folliculitis
Bacterial or Staphylococcus aureus folliculitis
It is a common form of folliculitis that occurs when your hair follicles are infected by Staphylococcus aureus. This type of bacteria is normally present on our skin and are harmless. The only time it brings us harm is when it gains access in our body.
Pityrosporum or Malassezia folliculitis
This is a type of folliculitis, also considered as common like bacterial folliculitis, that occurs when bacteria known as yeast gets inside your hair follicles and infects it. These are bumps that are physically like acne and is commonly mistaken as returning acne because those who have acne are prone to having folliculitis. So, people tend to treat it the way acne is treated. When people have Malassezia folliculitis, there is also a possibility that they may have seborrheic eczema or dandruff.
If you are a man with curly hair and shaves very close to the skin or a woman that waxes hair in the genital area, you are more likely to grow Pseudofolliculitis barbae or known as Barber’s itch. There is a huge chance that you’ll have keloids or dark scars that are raised in the affected area.
Pseudomonas or hot tub folliculitis
This type of folliculitis shows signs of infection like itchiness and redness of skin bumps around the hair follicles 2 days after initial infection. The bacteria called Pseudomonas is the cause of having hot tub folliculitis. From the name itself, you can get this type of bacteria in poorly maintained hot tubs or spa.
Types of Deep Folliculitis
Furuncles and carbuncles
Furuncles are commonly known as boils and a group of boils is called carbuncles. This another effect manifested because of the infection caused by Staphylococcus aureus in the hair follicles. It can be a very painful bump and is either pink or red.
It is a chronic and an uncontrollable type of folliculitis that is normally found in the beard. Inflammation is not only found in the follicles but also on the skin around it. Often times, the infection is caused by Staphylococcus aureus but can be caused by other forms of bacteria.
This type of folliculitis is a bacterial infection and appears to look like acne. In most cases, the cause of gram-negative folliculitis is a long-standing acne treatment using medications like topical antibiotics or tetracycline.
Eosinophilic folliculitis or EPF acquired its name after finding eosinophils, a type of white blood cell that fight diseases, around the infected follicles during a skin biopsy performed on a person infected with this specific skin disorder. This type of folliculitis appears most frequently on men compared to women. You may distinguish EPF when you see red bumps on the skin that are itchy, and you evidently see pustules or classic pimples. Papules, bumps that are red or pink in color and are hard when touched, may also show and remain for a couple of weeks to a few months, and would mostly grow on the neck, scalp or face.
Causes of Folliculitis
The most common cause for folliculitis, even with its different types, is the Staphylococcus aureus bacteria. You can acquire this kind of bacteria through direct contact with a person infected with Staphylococcus aureus or from their personal items that have already been contaminated with the bacteria like razors and towels. The bacteria can also be acquired indirectly by going to pools or spas that have been contaminated and are poorly maintained. Other agents that can cause various type of folliculitis are tinea rubrum, herpes simplex virus (HSV) and sycosis barberis.
You are also prone to having folliculitis if you are infected with HIV, which makes your immune system weak from fighting off infection like viruses. Men who have curly hair and frequently shaves are more likely to have folliculitis. Other risk factors are wearing tight clothing that traps sweat and heat or when you have acne.
When diagnosing folliculitis, the initial thing performed by medical practitioners is a physical examination to assess the condition of the skin bumps. The doctor must be informed on how long you have had skin bumps if you previously had folliculitis and what other symptoms are you experiencing since you had skin bumps. Depending on how serious the infection is, a biopsy may be done to get a more accurate diagnosis.
You may apply some preventive measures to decrease the chances of acquiring this type of skin disorder but will not be a guarantee that you’ll never be infected. The most important thing to consider is always to wash your hands properly to avoid carrying the bacteria on your hands for a long time. Refrain from wearing very tight clothing that traps heat and irritates your skin. If you are using oil or greasy products on your skin, put a restriction on using because too much use can trap the bacteria on the skin. Only use such when necessary. If you wish to really dip yourself in hot tubs, make sure that these tubs are properly maintained and are clean. Also, make sure that razors and towels that you are clean and do not allow other people to borrow these items.
Treatments for Folliculitis
There are various ways to treat folliculitis and the treatment that will be used varies also on how serious the infection is. You also have to consider as to what steps have you taken to treat the infection. The medications that will be mentioned in this article may work well but there is no guarantee that it will not recur after the treatment.
If you wish to control the infection or if the infection is mild, you may opt to use topical antibiotics. You may also use lotion or gel that can stop the infection from growing. With mild infections, you may not be prescribed oral antibiotics as it will be used on a more serious type of folliculitis. Since folliculitis can be caused by either a fungal infection or a bacterial infection, using antibiotics may not help in this case. The doctor may prescribe you pills to combat fungal infections. You may also be prescribed to use antifungal creams and shampoos.
When you acquired a type of folliculitis that is very itchy and painful like EPF, you may be prescribed to use topical steroids to alleviate pain and itching. If you have been infected with HIV, you may be advised to have antiretroviral therapy or ART as it can help in the decrease of symptoms of EPF. Minor surgery can also be an option when you have carbuncle or a big furuncle. Boils are filled with pus, so creating an incision on the boils will drain the pus and this method may decrease chances of scarring and time of recovery and it will also help ease the pain. Another type of surgery that you may opt is laser hair removal, but this can be expensive. The treatment would require several sessions to complete. Possible side effects of the surgery include permanent removal of hair, blisters, scars and skin discoloration on the area treated.