Folliculitis is a condition where the hair follicles become inflamed or infected, leading to small red or white-tipped bumps that look like pimples and may contain pus. It develops when a hair follicle is irritated, damaged, or blocked, which allows germs, most often the bacterium Staphylococcus aureus, and sometimes fungi to grow and cause inflammation.
Several everyday factors can trigger folliculitis, including shaving, tight clothing that rubs against the skin, sweating, sitting for long periods in hot tubs, or minor skin injuries. It can also result from blocked pores caused by oil, thick skin products, or certain skin conditions. Ingrown hairs, when a hair grows back into the skin instead of outward, can also lead to folliculitis, especially in areas that are shaved frequently or where the hair is curly.
Typical symptoms include itching, soreness, and pus-filled bumps around hair follicles that may crust over as they heal. Most cases are mild and go away on their own with proper skin care, such as keeping the area clean and avoiding irritation. However, more severe or long-lasting cases can develop into deeper boils and may cause scarring or permanent hair loss if not treated. In such situations, medical treatment may be needed, which can include topical creams, oral antibiotics, or draining of deeper infections.
Types of Folliculitis
Folliculitis can be classified into several types based on the underlying cause of inflammation or infection. Each type has distinct features, affects different areas of the body, and may require specific treatment approaches. The cause also influences how severe the symptoms become and how long the condition lasts.
- Bacterial folliculitis is the most common form and is typically caused by Staphylococcus aureus, a type of bacteria that normally lives harmlessly on the skin but can enter the hair follicle when the skin is irritated, broken, or damaged. It often presents as clusters of small, pus-filled bumps accompanied by redness, itching, or tenderness. This type can occur anywhere on the body where hair grows and is frequently associated with friction, sweating, or minor skin trauma.
- Fungal folliculitis develops when yeast or dermatophyte fungi infect the hair follicles. Yeast-related folliculitis (also called Malassezia folliculitis) is common in warm, humid environments and may resemble acne, particularly on the back and chest. Dermatophyte infections (ringworm-type fungi) can also affect the follicles, often causing more widespread redness and scaling. This form is typically more persistent than bacterial folliculitis and may worsen with standard acne treatments because some topical products can further disrupt the skin’s natural balance.
- Pseudofolliculitis barbae is a non-infectious but inflammatory form of folliculitis caused by ingrown hairs. It is most often seen in areas that are shaved regularly, especially the beard area in men. It occurs when curly hairs grow back into the skin after shaving, causing irritation and bumps that resemble pimples. This condition disproportionately affects individuals with tightly curled hair and is sometimes referred to as “razor bumps.” Chronic cases can lead to skin darkening (post-inflammatory hyperpigmentation) and scarring.
- Hot tub folliculitis, also called “Pseudomonas folliculitis,” is caused by Pseudomonas aeruginosa, a bacterium that thrives in warm, poorly chlorinated water such as hot tubs, heated pools, or whirlpools. The infection typically appears within 24 to 48 hours of exposure and commonly affects areas covered by swimwear, where moisture and friction help bacteria stay in contact with the skin. It is often self-limiting but can cause discomfort and widespread rashes if the exposure is prolonged.
- Viral folliculitis is uncommon and is usually linked to viral infections such as herpes simplex virus (HSV). It tends to produce painful rather than itchy lesions and may occur in association with cold sores or genital herpes outbreaks. This type requires antiviral therapy rather than antibiotics or antifungal treatment.
Because each type of folliculitis has a different cause, accurate diagnosis is important to ensure proper treatment. For example, bacterial folliculitis typically improves with antibacterial creams or oral antibiotics, whereas fungal folliculitis requires antifungal medication. In contrast, pseudofolliculitis barbae often responds best to changes in shaving habits rather than medical treatment.
Causes of Folliculitis
Folliculitis develops when a hair follicle becomes inflamed as a result of infection, irritation, or physical blockage. The inflammation may be triggered by a variety of organisms including bacteria, fungi, viruses, or parasites or by mechanical and chemical factors that damage the follicle and make it vulnerable to infection.
Bacterial Infections
Bacterial infection is the most frequent cause of folliculitis. The bacterium Staphylococcus aureus is responsible for the majority of cases. This organism is commonly found on human skin and inside the nose, where it normally does not cause harm. However, when the skin barrier is weakened, through shaving cuts, friction, insect bites, blocked pores, or minor injuries, it can enter the hair follicle and trigger inflammation.
Individuals with pre-existing skin conditions such as eczema, acne, or dermatitis are at higher risk because their skin barrier is already compromised. Symptoms of bacterial folliculitis typically include clusters of red bumps or pimples centered around hair follicles, often filled with pus and accompanied by itching or tenderness.
Another bacterium, Pseudomonas aeruginosa, can cause a specific form known as “hot tub folliculitis.” This usually occurs after exposure to warm, inadequately chlorinated water found in hot tubs, heated pools, or spa facilities. The bacteria thrive in moist environments
Fungal Infections
Fungal folliculitis occurs when yeast or dermatophyte fungi infect the hair follicle. The most common type is caused by the Malassezia species, a yeast that is part of the skin’s normal microbiome but can overgrow under certain conditions, especially in warm and humid climates. This type is more likely to appear on the chest, back, shoulders, and upper arms, and is sometimes mistaken for acne due to its similar appearance.
Dermatophytes, fungi that infect the skin, hair, and nails, can also cause folliculitis, often in association with ringworm-like rashes or tinea infections. People who sweat heavily, wear tight or non-breathable clothing, or have weakened immune systems are more vulnerable to fungal involvement. Symptoms may include persistent itching, redness, pustules, and sometimes scaling or flaking around the follicles.
Because fungal folliculitis does not respond to antibacterial treatments, correct identification of the organism is important. Antifungal therapy is required to resolve the infection, and recurrence may occur if underlying triggers like moisture, friction, or occlusion are not addressed.
Viral and Parasitic Causes
Viral folliculitis is less common than bacterial or fungal forms but can occur, especially in individuals with weakened immunity or those who already have viral skin infections. The herpes simplex virus (HSV), which causes cold sores and genital herpes, can infect nearby hair follicles, producing small clusters of painful blisters rather than itchy bumps. These lesions may break down into shallow ulcers before healing and typically require antiviral medication for management.
In rare cases, folliculitis can also be caused by microscopic parasites. One example is Demodex folliculorum, a type of mite that lives inside hair follicles and sebaceous (oil) glands. While these mites are normally harmless, overgrowth or increased skin sensitivity can trigger inflammation, particularly on the face and scalp. This condition, sometimes referred to as demodicosis, can resemble rosacea or other chronic skin disorders and may require specialized treatment to reduce mite populations.
Risk Factors
Various elements can increase the likelihood of developing folliculitis. These include habits related to cleanliness, certain health issues, and exposure to specific environmental conditions.
Personal Hygiene
Poor or inconsistent personal hygiene is one of the most prominent risk factors for folliculitis. When the skin is not cleaned regularly, sweat, dirt, and dead skin cells can accumulate around the follicles, creating an environment in which bacteria and fungi can multiply. Sharing personal items such as razors, towels, or washcloths also contributes to contamination, allowing microorganisms to transfer from one person’s skin to another’s. Certain grooming practices, especially frequent shaving, can cause tiny cuts or abrasions, making it easier for bacteria to enter the hair follicle.
Tight or non-breathable clothing can further aggravate the skin by trapping heat and moisture, which softens the outer layers of the skin and increases friction. This creates irritation and microtears, opening a pathway for infection. Environments that keep the skin warm and moist for extended periods such as after sweating from exercise or working in hot conditions also increase the risk of folliculitis unless the skin is dried thoroughly and quickly. Practicing good hygiene, using clean personal items, and reducing friction on the skin can significantly lower the likelihood of developing the condition.
Underlying Health Conditions
Certain medical conditions and physiological factors make individuals more susceptible to folliculitis. People with diabetes are at increased risk due to poor circulation and a slower immune response, both of which impair the body’s ability to fight off infections effectively. Similarly, individuals with weakened immune systems, whether from illnesses such as HIV/AIDS or from immunosuppressive medications used after organ transplants or during chemotherapy, have reduced defenses against bacterial, fungal, or viral pathogens.
Skin disorders that damage the protective outer layer of the skin, such as eczema or dermatitis, also expose follicles to infection. Persistent scratching or inflammation associated with these conditions disrupts the skin barrier, enabling microorganisms to penetrate more easily. Obesity may contribute as well, particularly because larger skin folds retain sweat and friction, creating warm environments conducive to microbial growth.
Environmental Triggers
Environmental conditions can increase the risk of folliculitis, especially when the skin is exposed to contaminated water or irritating substances. Hot tubs, spas, and swimming pools that are not properly cleaned or chlorinated can harbor Pseudomonas aeruginosa, the bacteria that causes hot tub folliculitis. In many cases, even a short time spent in such water can lead to outbreaks of red, itchy bumps over large areas of the skin.
Work-related exposure is another important risk factor. People who work around oils, grease, harsh chemicals, or dust such as mechanics, factory workers, or construction workers, may develop folliculitis because these substances irritate or block the hair follicles. Athletes and people living in warm, humid climates are also at higher risk. Frequent sweating softens the skin and creates a moist environment where bacteria and fungi can grow more easily. Wearing tight or non-breathable clothing, including sports uniforms or protective gear, can trap heat and moisture against the skin and make the problem worse.
Symptoms and Identification
Folliculitis can present with a range of skin changes depending on the cause, the depth of inflammation, and how long the condition has been present. Because the condition originates in the hair follicle, symptoms usually occur in areas of the body where hair grows. The appearance of the rash and associated discomfort can help distinguish mild cases from more serious infections that require medical attention.
Common Signs of Folliculitis
In its early or mild form, folliculitis typically appears as small, red bumps or white-headed pimples centered around hair follicles. These bumps may be itchy, sore, or tender to the touch. The inflammation is most often seen on the scalp, face, chest, back, buttocks, or thighs especially in areas where there is frequent friction, shaving, or sweating.
The surrounding skin may show mild redness or swelling, and the follicles can fill with pus as the body responds to infection or irritation. In some cases, the bumps may break open and release a small amount of pus before forming a light crust as they begin to heal. Mild folliculitis is usually self-limiting, meaning it often clears on its own within a few days to two weeks with proper hygiene and avoidance of further irritation.
Symptoms of Severe Cases
When folliculitis becomes deeper or more aggressive, the inflammation may extend below the surface of the skin, leading to painful swellings known as boils (furuncles) or clusters of boils called carbuncles. The affected area may feel warm to the touch and become significantly swollen or tender. As the infection progresses, the skin can become more intensely red, and the bumps may enlarge or spread.
In some severe or untreated infections, individuals may also experience systemic symptoms such as fever, fatigue, or a general feeling of illness (malaise), indicating that the infection is spreading or that the immune system is strongly reacting.
If inflammation damages the hair follicle over time, scarring or permanent hair loss may occur, particularly in chronic or untreated cases. This is more likely in deep infections or when the skin is repeatedly irritated by shaving, friction, or scratching.
Medical evaluation is recommended when the symptoms are persistent, painful, widespread, associated with fever, or do not improve with basic skin care. In these cases, treatment may involve topical or oral antibiotics, antifungal medications, or drainage of deeper lesions to prevent long-term complications.
Diagnosis of Folliculitis
The clinician carefully inspects the affected skin, noting the presence of small, red bumps or pustules centered around hair follicles. The distribution pattern and appearance such as clusters of inflamed follicles or single lesions offer clues about the cause.
Physical examination includes assessing for itching, tenderness, and signs of infection like crusting or swelling. History of recent shaving, hot tub use, or skin trauma is often reviewed, as these factors increase risk.
Identifying exact lesion types and locations on the body aids in distinguishing infectious from non-infectious folliculitis.
Laboratory Tests
When the cause is unclear or infections do not respond to initial treatment, laboratory testing is essential. A skin swab or pustule fluid sample may be collected to perform bacterial cultures or fungal tests.
Microscopic examination of samples can detect Staphylococcus aureus or other bacteria. In cases of recurrent or resistant folliculitis, blood tests or skin biopsy may be ordered.
Lab results confirm the specific pathogen involved, ensuring targeted antimicrobial therapy. Sensitivity testing may also guide appropriate antibiotic selection.
Treatment Options
Topical therapy is the first-line approach in mild to moderate folliculitis and is aimed at reducing microbial overgrowth and controlling local inflammation. Topical antibiotics, such as mupirocin and clindamycin, are commonly prescribed to treat superficial bacterial infections, particularly those caused by Staphylococcus aureus. They work by reducing bacterial proliferation at the follicular opening. In patients with recurrent staphylococcal folliculitis, topical decolonization regimens, including mupirocin intranasal application, may be recommended to eliminate nasal carriage of the bacteria, which is a common reservoir.
When the folliculitis is due to yeast or fungal species, particularly Malassezia (formerly known as Pityrosporum), antifungal creams such as ketoconazole, clotrimazole, or econazole are used to restore the microbial balance of the skin. Antiseptic washes like chlorhexidine, benzoyl peroxide, or povidone-iodine may be incorporated to reduce surface contamination, especially in high-friction or sweat-prone areas.
Topical corticosteroids are sometimes prescribed in cases where inflammation is predominant or when folliculitis develops from non-infectious irritants such as friction, ingrown hairs, or contact dermatitis. However, their use must be cautious and limited, because long-term or inappropriate steroid application can suppress local immunity and worsen infectious cases. Moisturizers and emollients may also be recommended to repair the skin barrier and reduce irritation.
Oral Therapies
Oral medications are reserved for more extensive, deep, or recurrent folliculitis that does not adequately respond to topical therapy. Oral antibiotics such as cephalexin, dicloxacillin, doxycycline, or trimethoprim-sulfamethoxazole are prescribed depending on the suspected organism and patient risk factors such as MRSA exposure. These therapies are especially useful when lesions involve multiple body regions, when folliculitis occurs around areas of thick hair such as the beard region, or when systemic symptoms such as fever appear.
For fungal folliculitis, especially in immunocompromised individuals or patients with persistent malassezia-induced lesions, systemic antifungals like fluconazole or itraconazole may be required when topical agents are not sufficient. In rare cases where folliculitis results from parasites such as mites (e.g., Demodex), oral antiparasitic therapy may be used.
In cases of sterile or non-infectious folliculitis, particularly those related to conditions like acneiform eruptions, ingrown hairs, or drug reactions, oral anti-inflammatory medications or retinoids such as isotretinoin may be indicated to reduce sebum production and follicular blockage. Treatment duration varies significantly: acute infections may resolve within 7–14 days, whereas chronic or recurrent cases may require longer-term therapy and lifestyle modification.
Procedural Treatments
In more severe presentations, folliculitis may evolve into furuncles (boils) or abscesses, where pus collects beneath the skin and cannot drain spontaneously. In such cases, incision and drainage are often required to evacuate the infected material and relieve pressure. This minor surgical procedure helps prevent the spread of infection into deeper tissues and supports faster recovery.
For individuals with chronic or relapsing folliculitis, particularly in areas where shaving repeatedly irritates the skin, laser hair removal can be an effective long-term management option. By reducing or permanently eliminating hair follicles in recurrently affected regions, laser therapy decreases bacterial colonization sites and friction, lowering recurrence frequency.
In certain resistant cases, physical removal of infected hairs or careful debridement of damaged tissue may be performed to control infection and promote healing. Such procedures are usually carried out by dermatologists under sterile conditions. In addition, patients are often counseled regarding hygiene practices, clothing choices, and shaving techniques to prevent reinjury to the follicles and reduce re-exposure to pathogens.
Prevention Strategies
- Daily cleansing with a mild, non-comedogenic cleanser helps remove sweat, oil, dead skin cells, and bacteria from around hair follicles.
- Avoiding harsh scrubs or rough sponges prevents microtears in the skin that increase infection risk.
- Keeping the skin moisturized with fragrance-free, hypoallergenic products helps maintain the protective skin barrier.
- Washing or rinsing the skin promptly after sweating reduces bacterial buildup in sweat-prone areas.
- Using clean, sharp, single-use or well-sanitized razors minimizes trauma to hair follicles during shaving.
- Shaving in the direction of hair growth reduces the likelihood of ingrown hairs and irritation.
- Applying shaving gels or creams provides lubrication and lowers friction on the skin.
- Trimming hair instead of close shaving can help individuals with curly hair avoid ingrown hairs.
- Wearing loose-fitting, breathable clothing reduces heat, friction, and moisture around hair follicles.
- Avoiding tight or synthetic fabrics prevents sweat and bacteria from being trapped against the skin.
- Limiting exposure to poorly maintained hot tubs and pools helps prevent waterborne folliculitis.
- Showering after contact with communal water facilities reduces the risk of Pseudomonas infection.
- Managing underlying conditions such as diabetes, obesity, or immune dysfunction lowers susceptibility to folliculitis.
- Maintaining proper nutrition and hydration supports healthy skin barrier function and healing.
- Doctors may recommend antiseptic washes or decolonization (e.g., mupirocin) for recurrent bacterial folliculitis.
- Regularly washing sports gear, towels, and shared equipment reduces surface contamination and infection spread.
Possible Complications
One of the most common complications of folliculitis is recurrence. Because the condition is often linked to ongoing triggers such as shaving irritation, friction from clothing, excessive sweating, or a weakened immune system, the infection may return even after an initial episode has cleared. In many cases, the causative bacteria or fungi can remain in the hair follicles or on the surrounding skin surface, creating a reservoir for reinfection.
Recurring folliculitis is especially common in people who carry Staphylococcus aureus on their skin or in their nasal passages (a state known as bacterial colonization). Without targeted treatment to eliminate this colonization, flare-ups continue to occur. Environmental factors, such as contaminated hot tubs or unsanitized gym surfaces, may also lead to repeated exposure.
Scarring and Permanent Skin Damage
Another significant complication of chronic or severe folliculitis is damage to the hair follicles and surrounding tissue. When inflammation penetrates deeper layers of the skin, as occurs with furuncles (boils) or carbuncles, the follicle can become permanently destroyed. This may lead to visible changes such as depressions, raised scars, or discoloration of the skin.
In more advanced cases, scarring alopecia can occur, meaning the hair in the affected region does not grow back. This form of hair loss is irreversible because the follicle itself has been replaced with scar tissue. Areas commonly affected include the scalp, beard region, and areas under consistent friction or shaving.
The risk of scarring increases when lesions are squeezed, improperly drained, or left untreated for long periods. Repeated scratching or secondary bacterial infection can also worsen tissue damage.
Folliculitis in Special Populations
Folliculitis presents unique challenges depending on the patient’s age and immune status. Treatment and progression vary, requiring tailored approaches for different groups.
Children
In children, folliculitis most commonly results from bacterial infections caused by Staphylococcus aureus. The condition often appears on the scalp, face, neck, and sometimes the buttocks, areas that are frequently irritated by sweat, friction from clothing, or scratching. Young children also have thinner and more delicate skin, which is more easily damaged and susceptible to infection.
Poor hygiene habits, frequent outdoor play, and skin irritation from tight clothing or sportswear can contribute to repeated infections in this age group. Additionally, children with eczema or other chronic skin conditions face a higher risk of folliculitis because their skin barrier is already compromised. Most cases in children are mild and respond well to topical antibiotics or gentle cleansing; however, recurrent cases may require further investigation for underlying bacterial colonization or allergies.
Immunocompromised Individuals
People with weakened immune systems face a significantly higher risk of both frequent and severe folliculitis. This group includes patients with HIV/AIDS, cancer patients undergoing chemotherapy, organ transplant recipients taking immunosuppressive drugs, and individuals with autoimmune diseases treated with long-term corticosteroids or biologic therapies.
In these patients, folliculitis may be caused not only by common bacteria but also by less typical organisms such as Malassezia yeasts, dermatophyte fungi, herpes simplex virus, or atypical mycobacteria (e.g., Mycobacterium fortuitum). These infections may spread more rapidly, involve deeper tissue layers, and be more resistant to standard therapy.
Because immunocompromised individuals cannot mount a strong inflammatory response, symptoms may be less obvious initially but progress rapidly if untreated. Treatment is often systemic rather than topical, and longer courses of therapy are common.
Elderly Adults
In older adults, folliculitis may occur more frequently due to age-related changes in the skin such as thinning of the epidermis, slower wound healing, and reduced immune response. Limited mobility, prolonged sitting, and the use of medical devices such as oxygen tubing or braces can cause friction-related folliculitis. Elderly patients living in long-term care facilities may also face increased exposure to antibiotic-resistant strains of Staphylococcus aureus, including MRSA (Methicillin-resistant Staph. aureus). For these individuals, early intervention and infection control measures are crucial.
Athletes & Physically Active Individuals
Folliculitis is also common among athletes due to constant sweating, tight sportswear, and prolonged friction. Repeated shaving of the body or beard region, use of shared sports equipment, and exposure to communal locker rooms or pools further increase risk.
Living With Folliculitis
Managing folliculitis requires consistent attention to skin hygiene and appropriate care to prevent worsening. Identifying when symptoms exceed normal irritation is crucial for timely treatment and avoiding complications.
Self-Care Guidance
Patients should keep affected areas clean and dry, using mild soap and lukewarm water. Avoid tight clothing and minimize friction on the skin to reduce irritation.
Applying warm compresses several times a day can help soothe inflammation and encourage drainage of any pus. Over-the-counter topical antiseptics or antibiotic creams may be used, but prolonged or excessive use should be avoided.
Shaving should be limited or done carefully with clean, sharp blades to prevent further damage to hair follicles. Moisturizers without heavy oils can maintain skin barrier function and reduce dryness.
When to Seek Medical Attention
Medical evaluation is necessary if folliculitis spreads, becomes extremely painful, or is accompanied by fever. Persistent or recurring outbreaks despite self-care also require professional assessment.
Signs of worsening infection, such as large boils, abscess formation, or lymph node swelling, indicate the need for prescription antibiotics or other treatments. Patients with weakened immune systems should consult a healthcare provider early.
If unsure about symptoms, prompt consultation can prevent complications and ensure proper management.