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Folliculitis
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Folliculitis

Diseases & Conditions A-Z

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WOMEN'S HEALTH

Hair/Nails/Skin

With common names like hot tub folliculitis and barber'sitch, folliculitis may sound more like a bad joke than a skin disorder. But this infection of the hair follicles is no laughing matter. Severe cases may cause permanent hair loss and scarring, and even mild infections can be uncomfortable and embarrassing.

Folliculitis usually appears as small, white-headed pimples around one or more hair follicles - the tiny pockets from which each individual hair grows. Most infections are superficial, affecting just the upper part of the follicle, and although they may itch, they're seldom painful. The pimples can occur almost anywhere on your body, but they are especially common on the face, scalp, thighs, legs and in the groin area.

Folliculitis often starts with damage to your hair follicles - either from a blockage of the follicles or from friction caused by clothing or shaving. Once injured, the follicle is susceptible to infection by bacteria, yeast or fungi. Barber's itch, for example, is a bacterial infection that's aggravated by shaving. Tinea barbae - roughly, barber's itch in Latin - is a similar infection caused by a fungus.

In many cases, the infection clears on its own. When it persists, your doctor may recommend treatment with a topical antibiotic. For more severe infections involving the entire follicle, you may need oral antibiotics or broad-spectrum antifungal agents.

Signs and symptoms

The signs and symptoms of folliculitis vary, depending on the type of infection. In superficial forms of the disorder, small pimples develop around one or more hair follicles. One way to distinguish a follicular pimple from acne is that with a follicular pimple you often can see the hair shaft at the center of the lesion. The pimples sometimes contain pus (pustules), and they may crust over or be surrounded by an area that's red and inflamed. The infection may itch or be somewhat tender, but it usually isn't painful. Deep folliculitis, which affects the entire hair follicle, can cause more severe signs and symptoms, including large, painful, pus-filled pimples that may leave scars when they heal.

Superficial forms of folliculitis include:

  • Pseudomonas folliculitis (hot tub folliculitis). You really do acquire this form of folliculitis from hot tubs — or at least from those contaminated with pseudomonas bacteria. The bacteria thrive in a wide range of environments, including wooden tubs with chlorine and pH levels that aren't well regulated. About 12 to 48 hours after you're exposed, you're likely to develop a number of red, round, itchy bumps that later may develop into small pus-filled blisters (pustules). The rash is likely to be worse in areas where your swimsuit holds contaminated water against your skin. You're at increased risk of infection if you have diabetes, a history of skin infections, or open cuts or sores.
  • Barber's itch. This type of folliculitis is marked by itchy, white, pus-filled lumps in the beard area in men and sometimes on the legs or underarms in women. It occurs when hair follicles that have been irritated by shaving become infected with Staphylococcus aureus (staph) bacteria. Although staph bacteria live on your skin all the time, they generally cause problems only when they enter your body through a cut or other wound.
  • Tinea barbae. Caused by a fungus (Trichophyton verrucosum or Tricophyton mentagrophytes) rather than by bacteria, this type of folliculitis also develops in the beard area in men. It's highly contagious and got its name because in the past it was spread by barbers who used contaminated razors. Like barber's itch, tinea barbae causes itchy, white bumps. The surrounding skin may also become reddened. A more serious, inflammatory form of the infection appears as pus-filled nodules that eventually form a crust and that may occur along with swollen lymph nodes and fever.
  • Pseudofolliculitis barbae. An inflammation of the hair follicles in the beard area, pseudofolliculitis barbae affects African American men and others with curly beards. It develops when shaved hairs curve back into the skin, leading to inflammation and sometimes to dark raised scars (keloid scars) on the face and neck.
  • Pityrosporum folliculitis. Especially common in young and middle-age adults, pityrosporum folliculitis produces chronic, red, itchy pustules on the back and chest and sometimes on the neck, shoulders, upper arms and face. It's caused by infection with a yeast-like fungus, Malassezia furfur, which is similar to the fungus that causes dandruff.
  • Herpetic folliculitis. Shaving through a cold sore — a small, fluid-filled blister caused by the herpes simplex virus — can sometimes spread the herpes infection to your hair follicles.

Types of deep folliculitis include:

  • Gram-negative folliculitis. This sometimes develops in people receiving long-term antibiotic treatment for acne. Antibiotics alter the normal balance of bacteria in the nose, leading to an overgrowth of harmful organisms (Gram-negative bacteria). In general this doesn't cause problems, and the flora in the nose return to normal once antibiotics are stopped. In a few people, however, Gram-negative bacteria spread to the cheeks, chin and jaw line, where they cause new, sometimes-severe acne lesions.
  • Boils and carbuncles. These occur when hair follicles become deeply infected with staph bacteria. A boil usually appears suddenly as a painful pink or red bump about 1/2 inch in diameter. The surrounding skin may also be red and swollen. Within 24 hours, the bump fills with pus. It grows larger and more painful for five to seven days, sometimes reaching golf-ball size before it develops a yellow-white tip that finally ruptures and drains. Boils generally clear completely in about two weeks. Small boils usually heal without scarring, but a large boil may leave a scar. A carbuncle is a cluster of boils that often occurs on the back of the neck, shoulders or thighs, especially in older men. Carbuncles cause a deeper and more severe infection than a single boil. As a result, they develop and heal more slowly and are likely to leave scars.
  • Eosinophilic folliculitis. Seen primarily in HIV-positive people, this type of folliculitis is characterized by recurring patches of inflamed, pus-filled sores, primarily on the face and sometimes on the back or upper arms. The sores usually spread, may itch intensely, and often leave areas of darker than normal skin (hyperpigmentation) when they heal. The exact cause of eosinophilic folliculitis isn't known, although it may involve the same yeast-like fungus responsible for pityrosporum folliculitis.

Causes

Every hair on your body grows from a follicle, a small pocket under the skin. Although follicles are densest on your scalp, they occur everywhere except your palms, soles and mucous membranes such as your lips.

Each follicle is attached to a small muscle. When you're cold or frightened, the muscle contracts, raising the hairs above the level of your skin and giving the appearance of "goose bumps." Just above these muscles are sebaceous glands that produce an oil (sebum) that lubricates your skin and coats each hair shaft. Sebum is carried to the follicles and skin in tiny ducts.

Normally, the follicles carry out these functions with few problems. But when they're damaged, they may be invaded by viruses, bacteria and fungi, leading to infections such as folliculitis.

The most common causes of hair follicle damage include:

  • Friction from shaving or tight clothing
  • Excess perspiration, which can block the follicles
  • Inflammatory skin conditions, including dermatitis and acne
  • Injuries to your skin such as abrasions, surgical wounds or abscesses — red, painful, swollen areas of infection
  • Use of plastic dressings or adhesive tape
  • Exposure to coal tar, pitch or creosote — common among roofers, mechanics and oil workers
Risk factors

Anyone can develop folliculitis, but certain factors make you more susceptible to the condition. These include:

  • Medical conditions that reduce your resistance to infection, such as diabetes, chronic leukemia, organ transplantation and HIV/AIDS
  • A pre-existing skin condition such as acne or dermatitis
  • Trauma to your skin from surgery or an abscess
  • Long-term antibiotic therapy for acne
  • Topical corticosteroid therapy
  • Obesity — folliculitis is more common in people who are overweight
  • Living in a warm, humid climate

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Last Modified : 03/15/08 12:40 AM