Monday, 16 February 2015

Follicalitis (Skin Rash)


What is Folliculitis?

Alternative Names for Follicalitis are :

Pseudofolliculitis barbae, Tinea barbae; Barber's itch, hot tub rash, & razor bumps.

Folliculitisis an inflammation of the hair follicles. Most of the skin is covered with tiny hairs which grow out of hair follicles Each hair on your body grows out of a tiny pouch called a follicle. One to hundreds of follicles can be affected anywhere that hair is present. Actually, acne vulgaris, the facial rash that teenagers develop, is a type of folliculitis. In folliculitis, many hair follicles in one area of the skin are affected.The affected hair follicles swell into small pus-filled pimples. Each individual pimple looks like a small, rounded, yellow-red spot.
You can have folliculitis on any part of your body that has hair. But it is most common on the beard area, arms, back, Chest, buttocks, and legs with the exception of the palms of the hands and soles of the feet. Folliculitis is inflammation of one or more hair follicles. It can occur anywhere on the skin.
Folliculitis usually affects those in their early adult life, and may persist till their early 30s. Warmer weather may worsen the condition.
Please click the below links to see some pictures to have a better understanding

What causes folliculitis?

It may be caused by bacteria. It also can be caused by yeast or another type of fungus. Folliculitis can be due to infection, occlusion (blockage), irritation and various skin diseases. Folliculitis can be caused by a large number of infectious organisms. Frequently folliculitis seems to be induced by irritating substances, environmental or anatomical defects, internal abnormalities and drugs.

The most common causes of follicle damage are:
  • Folliculitis is caused by an infection of hair follicles, usually from the bacteria Staphylococcus aureus. Folliculitis may also be caused by viruses, fungi and even an inflammation from ingrown hairs.
  • The condition is classified as either superficial or deep, based on how much of the hair follicle it involves. Deep folliculitis is usually more severe.
  • Follicles are densest on your scalp, and they occur everywhere on your body except your palms, soles, lips and mucous membranes. Damaged follicles are at risk of infection.
You are more likely to get folliculitis if you:
  • Use a hot tub, whirlpool, or swimming pool that is not properly treated with chlorine.
  • Wear tight clothes.
  • Frequent shaving or Friction from Shaving
  • Use or work with substances that can irritate or block the follicles. Examples include makeup, cocoa butter, motor oil, tar, and creosote.
  • Heat and sweat, such as that caused by wearing rubber gloves or waders
  • Certain skin conditions, such as dermatitis and acne
  • Taking some medications, such as steroid creams or long-term antibiotic therapy for acne
  • Injuries to your skin, such as from scrapes or surgical wounds
  • Coverings on your skin, such as plastic dressings or adhesive tape
  • Having a medical condition that reduces your resistance to infection, such as diabetes, chronic leukemia and HIV/AIDS
  • Being overweight
  • Sweat excessively 

What are the symptoms?

Common symptoms include a rash, itching, and pimples or pustules near a hair follicle in the neck, groin, or genital area. The pimples may crust over. The pimples may have pus in them, and they may itch or burn. When the pimples break open, they may drain pus, blood, or both.
"Hot tub folliculitis" most often appears about 72 hours after you've been in a hot tub or spa. Many small pimples appear on your stomachand sometimes on your arms and legs. You might have a mild fever and have an upset stomach. Most of the time, this kind of folliculitis goes away on its own in 7 to 10 days.

Folliculitis signs and symptoms include:
  • Clusters of small red bumps or white-headed pimples that develop around hair follicles
  • Pus-filled blisters that break open and crust over
  • Red and inflamed skin
  • Itchy or burning skin
  • Tenderness or pain
  • A large swollen bump or mass
  • Recurrent or spreading infection
  • Large, itchy patches of infected skin (plaques)
  • Boils under the skin (furunculosis)
  • Permanent skin damage, such as scarring or dark spots
  • Destruction of hair follicles and permanent hair loss

How is it treated?

  • Warm compresses made with saltwater orBurow's solution. These may ease itching and help healing. To make a warm compress, soak a hand towel in warm water that you have added salt or Burow's solution to. Wring out the excess water, and place the towel on the affected skin.
  • Medicated shampoo. It can be used to treat folliculitis on the scalp or beard.
  • Creams or pills to control infection.For mild infections, your doctor may recommend the antibiotic cream mupirocin (Bactroban). Oral antibiotics aren't routinely used for folliculitis. But for a severe or recurrent infection, your doctor may prescribe them.
  • Creams or pills to reduce inflammation.If you have mild eosinophilic folliculitis, your doctor may suggest you try a steroid cream. If your condition is severe, he or she may prescribe oral corticosteroids. Such drugs can have serious side effects and should be used for as brief a time as possible.
  • Apply over-the-counter antibiotics.Try various nonprescription infection-fighting gels, creams and washes.
  • Apply soothing lotions.Try relieving itchy skin with an oatmeal lotion or an over-the-counter hydrocortisone cream.
  • Clean the affected skin.Gently wash the infected skin twice a day with antibacterial soap. Use a clean washcloth and towel each time and don't share your towels or washcloths. Use hot, soapy water to wash these items. And wash clothing that has touched the affected area.
  • Protect the skin.If possible, avoid shaving. If you must shave, try an electric razor. When you're done, rinse your skin with warm water and apply moisturizer.
  • Use only clean hot tubs and heated pools.And if you own a hot tub or a heated pool, clean it regularly and add chlorine as recommended.
Call your doctor if you have folliculitis and:
  • It spreads or keeps coming back.
  • You have a fever over 101 °F (38 °C).
  • The affected area becomes red, swollen, warm, or more painful.
If the inflammation doesn't go away or keeps coming back, laser hair removal may be an option. Laser treatment destroys the hair follicles, so they can't get inflamed.

Other interventions

  • Minor surgery.If you have a large boil or a carbuncle, your doctor may make a small incision in it to drain the pus. This may relieve pain, speed recovery and help lessen scarring. Your doctor may then cover the area with sterile gauze in case pus continues to drain.
  • Light therapy with a medicated cream.Also called photodynamic therapy, this technique has helped people with folliculitis that did not clear up with other treatments. In a study of seven people who each had one treatment of photodynamic therapy, six people showed significant improvement four weeks later. In another study of one man, the technique completely cleared his folliculitis. And he remained free of symptoms 15 months after the last treatment.
  • Laser hair removal.If other treatments fail, laser therapy may clear up the infection. This method is expensive and may require several treatments. It permanently reduces the density of the hair in the treated area. Other possible side effects include discolored skin, scarring and blistering.

How can you prevent folliculitis?

There are many things you can do to prevent folliculitis or keep it from spreading.
  • Bathe or shower daily with a mild soap. Also, bathe or shower after you exercise and after you work around chemicals.
  • Avoid sharing towels, washcloths, or other personal items. If you have folliculitis, use a clean washcloth and towel each time you bathe.
  • Don't scratch the bumps.
  • Avoid shaving the bumps. If you must shave, change the razor blade each time.
  • Avoid using oils on your skin. Oils can trap bacteria in the pores of your skin and can cause folliculitis.
  • After you use public hot tubs or spas, shower right away with soap. If you own your own hot tub, follow the manufacturer's instructions for keeping it clean.
  • Reduce friction from clothing
  • Antibacterial washes such as benzoyl peroxide are often used to treat folliculitis, and resistant cases may need antibiotic pills to clear the skin.

Types of Folliculitis

  • Bacterial folliculitis.This common type is marked by itchy, white, pus-filled bumps. When bacterial folliculitis affects a man's beard area, it's called barber's itch. It occurs when hair follicles become infected with bacteria, usually Staphylococcus aureus (staph). Staph bacteria live on the skin all the time. But they generally cause problems only when they enter your body through a cut or other wound.

  • Hot tub folliculitis (pseudomonas folliculitis).This type is caused by pseudomonas bacteria. You may be exposed to these bacteria in many places, including hot tubs and heated pools in which the chlorine and pH levels aren't well-regulated. You may develop a rash of red, round, itchy bumps one to four days after exposure. These may later develop into small pus-filled blisters (pustules).
The rash is likely to be worse in areas where your swimsuit held contaminated water against the skin or where skin — such as the back of the thighs — came in direct contact with a contaminated surface.

  • Barber's itch / Sycosis barbae (pseudofolliculitis barbae). This type affects men who have begun to shave. At first, small pustules appear on the upper lip, chin and jaw. They become more prevalent over days and weeks as shaving continues. Severe sycosis barbae may cause scarring.This is an inflammation caused by ingrowing hairs. It mainly affects black men who shave and is most noticeable on the face and neck. People who get bikini waxes may develop barber's itch in the groin area. This condition may leave dark raised scars (keloids).

  • Pityrosporum (pit-ih-ROS-puh-rum) folliculitis.This type is especially common in teens and adult men. It's caused by a yeast infection and produces chronic, red, itchy pustules on the back and chest and sometimes on the neck, shoulders, upper arms and face.

  • Gram-negative folliculitis.This type sometimes develops if you're receiving long-term antibiotic therapy for acne. Antibiotics alter the normal balance of bacteria in the nose. This leads to an overgrowth of harmful organisms called gram-negative bacteria. In most people, this doesn't cause problems, and the bacteria in the nose return to normal once antibiotics are stopped. In a few people, the gram-negative bacteria spread to the skin around the nose and mouth. This can cause new, severe acne.

  • Boils (furuncles) 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. The surrounding skin also may be red and swollen. The bump then fills with pus and grows larger and more painful before it finally ruptures and drains. Small boils usually heal without scarring. A large boil may leave a scar.  A carbuncle is a cluster of boils. It usually appears on the back of the neck, shoulders, back or thighs. A carbuncle causes a deeper and more severe infection than does a single boil. As a result, it develops and heals more slowly and is likely to leave a scar.

  • Eosinophilic (e-o-sin-o-FILL-ik) folliculitis.This type mainly affects people with HIV/AIDS. Symptoms include intense itching and recurring patches of inflamed, pus-filled sores on the scalp, face, neck and upper chest. The sores usually spread and often leave areas of darker than normal skin (hyperpigmentation) when they heal. The exact cause of eosinophilic folliculitis isn't known. But it may involve the same yeast-like fungus responsible for pityrosporum folliculitis.

Steroid folliculitis

Systemically administered or topically applied steroids (cortisone medications) are a well-known cause of folliculitis.

Cutting oil folliculitis

Machinists exposed to insoluble cutting oils that are use to decrease the friction between machine tools and metal parts can develop a folliculitis on the exposed skin.

Staphylococcal folliculitis

Staphylococci are bacteria that commonly inhabit the skin. Occasionally, this organism may be insensitive to a number of commonly used antibiotics. In this situation, it is very important that a culture of the organism with sensitivities be performed so the ideal antibiotic is selected.

    may occur when Herpes Simplex Virus infection spreads to nearby hair follicles - mostly around the mouth

Is folliculitis contagious?

Although most cases of folliculitis are not contagious, cases caused by an infection may be transmitted through person-to-person skin contact, shared razors, or through Jacuzzis or hot tubs. Folliculitis may be sterile (noninfectious) or caused by a fungus, bacterium, or virus. It is possible to give it to someone else through close skin contact. Some people are simply more prone to developing folliculitis because of their overall health, possible altered immune status, exposure history, and other predisposing skin conditions like eczema or severely dry skin.

Folliculitis due to contact reactions


Paraffin-based ointments, moisturisers, and adhesive plasters may all result in a sterile folliculitis. If a moisturiser is needed, choose an oil-free product, as it is less likely to cause occlusion.


Coal tar, cutting oils and other chemicals may cause an irritant folliculitis. Avoid contact with the causative product.

Topical steroids

Overuse of topical steroids may produce a folliculitis. Perioral dermatitis is a facial folliculitis provoked by moisturisers and topical steroids. Perioral dermatitis is treated with tetracycline antibiotics for six weeks or so.

Folliculitis due to drugs

Folliculitis may be due to drugs, particularly corticosteroids (steroid acne), androgens (male hormones), ACTH, lithium, isoniazid (INH), phenytoin and B-complex vitamins. Protein kinase inhibitors (epidermal growth factor receptor inhibitors) and targeted therapy for metastatic melanoma (vemurafenib, dabrafenib) nearly always result in folliculitis.

Buttock folliculitis

Folliculitis affecting the buttocks is quite common and is often nonspecific, ie no specific cause is found. Buttock folliculitis is equally common in males and females.
  • Acute buttock folliculitis is usually bacterial in origin (like boils), resulting in red painful papules and pustules. It clears with antibiotics.
  • Chronic buttock folliculitis does not often cause significant symptoms but it can be very persistent. Although antiseptics, topical acne treatments, peeling agents such as alphahydroxy acids, long courses of oral antibiotics and isotretinoin can help buttock folliculitis, they are not always effective. Hair removalmight be worth trying if the affected area is hairy. As regrowth of hair can make it worse, permanent hair reduction by laser or intense pulsed light (IPL) is best.

Source :


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