Folliculitis
Symptoms, Causes & Treatment
Understanding folliculitis: what causes it, how to treat it, and how to prevent recurrent infection of hair follicles.
What Is Folliculitis?
Folliculitis is inflammation of the hair follicles, presenting as small, red, often pus-filled bumps around individual hairs. It is one of the most common skin conditions, affecting people of all ages and skin types.
Folliculitis can be superficial (affecting only the upper part of the follicle) or deep (extending into the deeper part of the follicle and surrounding tissue). Superficial folliculitis is far more common, usually mild, and often resolves without treatment. Deep folliculitis is more painful and may lead to complications such as boils (furuncles), carbuncles, and scarring.
The condition can be caused by bacterial infection (most commonly Staphylococcus aureus), fungal infection, viral infection, or non-infectious irritation (friction, shaving, occlusion). It can occur anywhere on the body where hair grows, but the most commonly affected areas are the beard area (face and neck), scalp, chest, back, buttocks, and thighs.
What Are the Symptoms of Folliculitis?
Folliculitis typically presents with clusters of small red pustules centred on hair follicles. Recognising the distribution and depth guides treatment choices.
Small, red, inflamed bumps or pustules around hair follicles · Pus-filled spots surrounding a hair · Itching, burning, or tenderness of affected area · Clusters of red spots on beard area, thighs, buttocks, underarms, or back
Rapidly spreading cellulitis from folliculitis · Furuncle (boil) or carbuncle formation · Folliculitis on face with risk of cavernous sinus thrombosis · Fever with deep skin infection · Folliculitis decalvans (scarring hair loss) — specialist dermatology referral
Seek urgent assessment if folliculitis progresses to a large, painful fluctuant lump (abscess/carbuncle), if surrounding skin becomes very red and warm (cellulitis), or if you develop fever.
What Causes Folliculitis?
Folliculitis results from infection or physical irritation of hair follicles. Identifying the cause guides appropriate treatment.
Bacterial folliculitis is most commonly caused by Staph aureus. Hot tub folliculitis is caused by Pseudomonas aeruginosa after immersion in inadequately chlorinated water. Pityrosporum (Malassezia) folliculitis is fungal.
Ingrown hairs (pseudofolliculitis barbae) are common in people with curly hair, particularly in the beard, neck, and groin. Shaving at an angle and using single-blade razors reduces the risk.
Contact dermatitis occurs when skin comes into contact with an irritant (irritant contact dermatitis) or a specific allergen (allergic contact dermatitis via type IV delayed hypersensitivity). Common allergens: nickel, latex, fragrances, preservatives.
Common eczema triggers include wool, synthetic fabrics, dust mites, pet dander, pollen, mould, soaps, detergents, food allergens (in children), and emotional stress. Identifying and avoiding personal triggers reduces flare frequency.
Psoriasis is an immune-mediated chronic inflammatory skin disease. T-cell activation drives rapid keratinocyte proliferation (3–5 days instead of 28–30), producing the characteristic thickened plaques.
Multiple psoriasis triggers are recognised: streptococcal throat infection (especially guttate psoriasis), medications (lithium, beta-blockers, antimalarials, NSAIDs), stress, trauma (Koebner phenomenon), alcohol, and smoking.
Key Risk Factors
How Is Folliculitis Diagnosed?
Folliculitis is diagnosed clinically. Skin swab of pustule fluid identifies the causative organism. KOH examination and fungal culture identify Malassezia folliculitis. Wood’s light may assist fungal diagnosis.
How Is Folliculitis Treated?
Treatment depends on the causative organism and depth of infection. Superficial bacterial folliculitis responds to topical antiseptics or antibiotics; deep infections require oral antibiotics.
Supportive Measures
Apply warm compresses to encourage pustules to discharge. Keep the area clean with antiseptic wash. Avoid shaving or tight clothing over affected areas until resolved. Do not squeeze or pop pustules — this spreads infection.
Recurrent Folliculitis: Investigation and Management
Recurrent folliculitis may indicate Staphylococcus aureus nasal carriage. A nasal swab and decolonisation treatment (nasal mupirocin, chlorhexidine body wash) can break the recurrence cycle. Investigate for diabetes and immunodeficiency in persistent or severe cases.
When Should You Seek Medical Advice for Folliculitis?
Large, rapidly expanding abscess (carbuncle) requiring urgent surgical drainage · High fever with spreading skin infection suggesting cellulitis.
Folliculitis has not responded to topical treatment after 2 weeks · A boil is developing · You have recurrent episodes of folliculitis · You are diabetic or immunocompromised with a skin infection.
How Can You Prevent Folliculitis?
Most folliculitis is preventable with good hygiene and appropriate skin care practices.
Good shaving technique significantly reduces folliculitis. Use a single-blade or safety razor, shave in the direction of hair growth, and replace blades frequently. Consider electric shaving or laser hair removal for chronic pseudofolliculitis barbae.
Wear breathable cotton or moisture-wicking fabrics. Avoid occlusive clothing after exercise. Shower promptly after exercise. All hot tubs and swimming pools should be properly chlorinated — report inadequate chlorination.
Frequent, effective milk removal is the most important mastitis prevention. Feed or express every 2–3 hours; never skip feeds. Get breastfeeding support from a midwife, health visitor, or lactation consultant early — before problems develop.
Ensure your baby latches on deeply and correctly. A poor latch causes nipple trauma (cracks), which are an entry point for bacteria. Ask for a latch assessment if breastfeeding is painful.
Seek breastfeeding support immediately if you notice breast hardness, redness, or pain. Early identification and treatment of blocked ducts prevents progression to mastitis and abscess.
SPF 30+ sunscreen daily is the single most effective measure against all types of hyperpigmentation, including melasma, PIH, and solar lentigines. UV exposure stimulates melanin even on cloudy days. Apply year-round to face and neck.
Speak to a Clinician About Folliculitis
Through The GP Service, a licensed clinician can assess folliculitis, prescribe appropriate antibiotic or antifungal treatment, and advise on preventing recurrence.
Expert clinical advice, when you need it.
Folliculitis FAQs
Folliculitis is most commonly caused by Staphylococcus aureus bacteria. Hot tub folliculitis is caused by Pseudomonas aeruginosa. Fungi, viruses, and physical irritation (tight clothing, shaving) can also cause folliculitis.
Mild folliculitis often resolves within 2 weeks with good hygiene and avoiding further irritation. Bacterial folliculitis may require topical or oral antibiotics. Persistent or recurrent cases should be assessed by a clinician.
Avoid tight clothing, use an electric shaver instead of blades, shave in the direction of hair growth, keep skin clean and dry, and avoid sharing towels or razors. These measures significantly reduce folliculitis risk.
Yes. Malassezia folliculitis (pityrosporum folliculitis) is a fungal infection of hair follicles that mimics acne. It is treated with antifungal shampoos or oral antifungals rather than standard acne treatments.
Topical antiseptics (chlorhexidine wash), topical antibiotics (fusidic acid, mupirocin), or oral antibiotics (flucloxacillin) depending on severity. Antifungals for fungal folliculitis. A clinician will determine the appropriate treatment.
Pseudofolliculitis barbae (razor bumps) is inflammation caused by ingrown hairs after shaving. It is most common in men with curly hair. Management includes changing shaving technique, topical retinoids, and sometimes laser hair removal.
Yes. Recurrent folliculitis may be due to Staphylococcus aureus nasal carriage. A nasal swab can identify carriers, and decolonisation treatment (nasal mupirocin, chlorhexidine washes) can break the cycle of recurrence.
Furuncles (boils) and carbuncles are deep folliculitis infections requiring incision and drainage. Recurrent boils should prompt investigation for diabetes, immunodeficiency, and Staphylococcus aureus carriage.