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
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
Sometimes folliculitis goes away on its
own in two or three days, but persistent or recurring cases are likely
to require treatment. The therapy your doctor recommends depends on the
type and severity of your infection.
- Pseudomonas folliculitis (hot tub
folliculitis). Hot tub folliculitis rarely requires treatment,
although your doctor may prescribe an oral or topical medication to
help relieve itching (anti-pruritic). More serious cases may require
an oral antibiotic.
- Barber's itch. Your doctor may
advise not shaving the affected area until the infection heals. If
you must shave, use an electric razor or clean razor blade every
time. If the problem persists, you may need topical or oral
- Tinea barbae. This infection —
especially the inflammatory form — can be effectively treated with
oral anti-fungal medications.
- Pseudofolliculitis barbae. The
best treatment for this condition is preventive. Shaving with an
electric razor, which doesn't cut as closely as a razor blade does,
can help. If you do use a blade, massage your beard area with a
warm, moist washcloth or facial sponge to lift the hairs so they can
be cut more easily. Use a shaving gel instead of cream, and shave in
the direction of the hair growth. When you're finished, rinse
thoroughly with warm water and apply a moisturizing aftershave. If
these measures don't help, your doctor may prescribe the acne
medication tretinoin (Retin-A).
- Pityrosporum folliculitis. Topical
or oral antifungals are the most effective treatments for this type
of folliculitis. Because the condition often returns once you've
finished the course of oral medication, your doctor may recommend
using topical ointments indefinitely. Antibiotics aren't helpful in
treating pityrosporum folliculitis and may make the infection worse
by upsetting the normal balance of bacteria on your skin.
- Herpetic folliculitis. If you're a
healthy adult, herpetic folliculitis may clear without treatment in
seven to 10 days. But if you're living with HIV/AIDS or you
experience frequent cold sores, your doctor may prescribe an oral
antiviral medication such as acyclovir (Zovirax), famciclovir (Famvir)
or valacyclovir (Valtrex). Although these drugs can clear the
infection, they won't necessarily prevent it from recurring. They
also may cause side effects such as headache, diarrhea, nausea and
- Gram-negative folliculitis.
Although this type of folliculitis results from long-term antibiotic
therapy for acne, it's usually treated with certain antibiotics or
with isotretinoin (Accutane).
- Boils and carbuncles.
Your doctor may drain a large boil or carbuncle by making a small
incision in the tip. This relieves pain, speeds recovery and helps
lessen scarring. Deep infections that can't be completely cleared
may be covered with sterile gauze so that pus can continue to drain.
Sometimes your doctor may prescribe antibiotics to help heal severe
or recurrent infections.
- Eosinophilic folliculitis.
A number of therapies are effective against eosinophilic
folliculitis but topical corticosteroids are often the treatment of
choice. Your doctor may prescribe a short course of oral
corticosteroids if you have a severe infection. All steroids can
have serious side effects and should be used for as brief a time as
possible. If you're living with HIV/AIDS and have mild eosinophilic
folliculitis, your doctor may prescribe topical steroids in
conjunction with oral antihistamines. More severe cases may require
treatment with isotretinoin (Accutane) for several months.
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