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Folliculitis (Skin)

Inflammation of hair follicles caused by bacterial, fungal, viral, or non-infectious mechanisms presenting as pruritic or tender perifollicular papules and pustules treated with hygiene, topical and systemic antimicrobials, and trigger avoidance.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dermatoloji department. Book Appointment →

What is Folliculitis (Skin)?

Folliculitis is inflammation centered on hair follicles, producing erythematous, often itchy or tender, papules and pustules at follicular openings. It is the most common pyoderma seen in dermatologic practice and can affect any hair-bearing area, with the beard, scalp, axillae, buttocks, and thighs frequently involved; chronic or recurrent disease can lead to scarring, hyperpigmentation, and follicular destruction.

Causes are categorized as infectious (bacterial: Staphylococcus aureus most common, Gram-negatives in oily skin, Pseudomonas in hot tubs; fungal: Pityrosporum/Malassezia, dermatophytes; viral: herpes simplex, molluscum; parasitic: Demodex), and non-infectious (irritative: shaving, occlusive clothing, oily products; eosinophilic in HIV; pseudofolliculitis barbae; folliculitis decalvans). Diagnosis is clinical with culture, KOH, biopsy, or PCR for refractory cases.

Management starts with identifying the cause, eliminating triggers, and instituting good hygiene (warm compresses, antibacterial cleansers). Topical therapy includes mupirocin, clindamycin, benzoyl peroxide, ketoconazole, or terbinafine; systemic agents are used for extensive bacterial folliculitis (cephalosporin, doxycycline), Pityrosporum (oral itraconazole or fluconazole), or refractory disease. Long-term prevention emphasizes shaving technique, decolonization protocols for recurrent S. aureus, and avoidance of contaminated hot tubs.

Symptoms

Erythematous papules and pustules centered on hair follicles
Itching, tenderness, or burning at follicular sites
Distribution on beard, scalp, trunk, axillae, buttocks, thighs
Hot tub folliculitis: itchy papules on areas covered by swimsuit 1-3 days after exposure
Pityrosporum folliculitis: itchy uniform papules on upper back and chest, refractory to acne therapy
Eosinophilic folliculitis (HIV): chronic itchy papules on face and trunk
Pseudofolliculitis barbae: ingrown hair papules and hyperpigmentation in beard area

Risk Factors

Shaving and waxing practices
Hyperhidrosis, occlusive clothing, hot/humid climates
Contaminated hot tubs, swimming pools, or whirlpools
Oily skin and use of comedogenic products
Diabetes, immunosuppression, HIV, prolonged antibiotic use
Topical or systemic corticosteroid use
Nasal Staphylococcus aureus colonization and household contacts

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent or extensive folliculitis unresponsive to home care
  • Spreading lesions, fever, or systemic symptoms
  • Recurrent boils suggesting MRSA or chronic carriage
  • Scarring, alopecia, or follicular destruction
  • Suspected fungal, herpetic, or eosinophilic folliculitis
  • Severe pseudofolliculitis barbae affecting daily life
  • Immunocompromised patients with new or atypical folliculitis

Treatment Methods

01
Hygiene measures: warm compresses, antibacterial cleansers (chlorhexidine, benzoyl peroxide), avoidance of occlusive products and tight clothing
02
Topical antimicrobials: mupirocin, clindamycin, fusidic acid for bacterial; ketoconazole, ciclopirox for Pityrosporum
03
Oral antibiotics for extensive bacterial folliculitis: cephalexin, dicloxacillin, doxycycline; clindamycin or TMP-SMX for MRSA per local susceptibility
04
Oral antifungals for Pityrosporum or refractory: itraconazole or fluconazole short courses
05
Decolonization for recurrent S. aureus: nasal mupirocin twice daily for 5 days, chlorhexidine body wash, household contact treatment
06
Hot tub folliculitis: usually self-limited; topical care, avoid contaminated water; chlorinate pools and hot tubs properly
07
Pseudofolliculitis barbae: shaving technique modification, single-blade or electric razor, exfoliation, topical retinoids; long-term laser hair reduction; long-term follow-up to prevent recurrence and address scarring

Which Department to Visit?

You can visit our Dermatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.