Folliculitis is a common skin disorder where the hair follicles become inflamed and sometimes infected. Dermatological conditions that also fall in the folliculitis category include hot tub rash, barber’s itch and razor burn. With over 5 million hairs on the average human body, folliculitis can occur anywhere. It affects all ages and results in very itchy and sore patches that can be embarrassing when they appear on the face, scalp, neck, arms and legs. (1, 2)
While some cases of folliculitis are sterile (meaning non-infectious) in nature, many cases are caused by bacterial or fungal infections. When hair follicles become infected, they may first appear like white-head pimples or red bumps. These bumps eventually will weep and turn into non-healing crusty sores.
Eruptions that come on quickly are often due to Staphylococcus aurea bacteria, while chronic or recurring folliculitis may be due to co-occurring medical conditions that make you more susceptible to infection. The infection can spread, leading to a more widespread problem, so proper treatment is necessary. (3)
While folliculitis is not considered a serious health condition, without effective management and treatment it can lead to skin damage including dark spots and scarring. Like pruritus, a common skin condition, it can be challenging to find the right treatment, but there are a wide range of conventional and natural remedies that may provide relief and prevent further discomfort and damage.
What Is Folliculitis?
Folliculitis is an extremely itchy rash that affects the hair follicles causing a pimple-like rash leaving skin painful and tender. The first signs may be clusters of small red bumps or white-head pimples filled with pus. If the infection progresses, the pus-filled bumps will break open and crust over.
This common skin condition can be caused by certain bacteria, viruses, fungi, parasites, yeast, ingrown hairs and certain medications. It can also be caused when moisture is trapped against the skin due to tight clothing, tight hair braids or by wearing rubber gloves or boots for extended periods. (4)
Folliculitis is not life-threatening, however when it occurs in visible areas this benign skin disorder can be embarrassing and lead to scarring and skin damage.
Signs and Symptoms
The most common symptoms of folliculitis are the appearance of clusters of red bumps or white pus-filled bumps that resemble pimples. Intense itching and soreness is common.
There are two groups of folliculitis — superficial folliculitis and deep folliculitis, each including several types with different root causes. The superficial group affects just a small part of the follicle while the deep folliculitis group is more severe, affecting the entire follicle. (5)
- Bacterial Folliculitis. Very common. It’s marked by itchy, white pus-filled bumps often caused by the S. aureus bacteria. The staph bacteria live on the skin all of the time, but generally only cause a problem when entering the body through a cut, scrape or a wound.
- Hot Tub Folliculitis. Generally, this type appears as a rash of round red bumps that are extremely itchy. They typically occur 24 to 48 hours after exposure to the Pseudomonas bacteria, which is often found in hot tubs and heated pools that are not properly chlorinated and pH balanced.
- Razor Bumps/Burn or Pseudofolliculitis Barbae. Caused by ingrown hairs most often on the face and lower legs. It is most common in men with curly hair who shave too close to the skin. It can also affect the lower legs and bikini line. This type may leave dark, raised scars.
- Pityrosporum Folliculitis. Caused by a yeast infection, this type of folliculitis produces chronic, red pus-filled bumps on the back, chest, neck, shoulders, upper arm and sometimes the face.
- Sycosis Barbae. Typically affects younger men and adolescents who have just begun to shave.
- Gram-negative Folliculitis. Individuals receiving long-term antibiotic therapy for acne are the most common group affected by this type.
- Boils and Carbuncles. Generally, it appears quite suddenly as clusters of boils or painful pinkish red bumps as a result of a staph bacterial infection deep in the follicle.
- Eosinophilic Folliculitis. This type is associated with individuals who have HIV/AIDS and is a recurring problem. It causes intense itching and widespread patches of pimples near the face and on the upper body.
Recognized risk factors include: (6)
- Chronic leukemia
- Certain types of cancer
- Seborrheic dermatitis
- Long-term antibiotic therapy for acne
- Immune-suppressing drugs
- Chemotherapy treatments
- Being a male with curly hair who shaves
- Soaking in a hot tub or swimming in a heated pool that is not properly chlorinated
- Wearing clothing that traps heat and sweat against the body
Recognized causes of folliculitis include: (7)
Bacterial Infection: S. aureus bacteria and Pseudomonas bacteria cause painful, weeping boils. These types of bacteria are common on the skin and thrive in the heated waters of a hot tub or swimming pool that is not properly chlorinated.
Yeast Infection: Pityrosporum ovale and Candida albicans are the two types of yeast most commonly associated with folliculitis. For young adults, P. ovale affects the upper chest and back while C. albicans can affect any skin fold as well as around the beard on males.
Fungi: Ringworm of the scalp can cause folliculitis symptoms and result in scaly hair loss.
Viral Infection: Certain common viruses including the herpes simplex virus and herpes zoster (shingles) virus can cause folliculitis. In infants and young children, the virus molluscum contagiosum can be the root cause of clusters of painful bumps in skin folds.
Parasitic Infection: This type of infection most often affects immunosuppressed adults and healthy seniors. Hair follicle mites can infect the scalp and face. In some cases, scabies can trigger folliculitis resulting in painful, weeping sores that heal slowly.
Ingrown Hairs: Often a result of improper shaving, electrolysis, plucking or waxing. Unless there is a presence of bacteria on the skin, it generally does not become infected.
Contact Reaction: Certain topical preparations including paraffin-based ointments, moisturizers, certain chemicals and the overuse of topical steroids are associated with folliculitis.
Medications: Certain medications including corticosteroids, androgens, ACTH, lithium, isoniazid, phenytoin, B-complex vitamins, protein kinase inhibitors, and certain medications for metastatic melanoma can cause folliculitis.
Underlying Skin Diseases: Acne, acne-like disorders, lichen planus and discoid lupus erythematosus can cause folliculitis.
While many cases of folliculitis will resolve within a week or two with good hygiene and self-management, if you have a severe case or your folliculitis often reoccurs, a visit to your physician is warranted.
For a diagnosis, a physical examination and medical history is required. To determine the type of infection, the doctor may swab the skin to capture samples of the infecting agent to determine the right course of treatment. In rare cases, a skin biopsy may be required to rule out a more serious underlying medical condition. The treatment will depend on the type of folliculitis you have and the severity. Some of the possible conventional treatments that can be recommended include: (8)
- Antibiotic creams, gels or lotions
- Antifungal creams, shampoos or oral medications
- Corticosteroids, either topical or oral, to reduce inflammation and itching
- Surgical procedure to drain pus from boil
- Laser hair removal
According to The American Osteopathic College of Dermatology, laser hair removal may work when other treatments fail, particularly on the lower legs. (3)
Natural Home Remedies
1. Apple Cider Vinegar Pack
According to a study by researchers from the University of Birmingham in the United Kingdom, acetic acid, or vinegar, is shown to inhibit the growth of certain strains of bacteria. They studied the responses of many bacteria to vinegar and found that Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae, and Enterobacter were the most positively affected by vinegar at a concentration of 0.16 percent to 0.3 percent. (9)
Lead researcher Dr. Mark Webb stresses in the study that vinegar has been used as medicine for 6,000 years to treat the plague as well as ear, chest and urinary tract infections. The team at the University of Birmingham was spurred to find a natural, effective and cost-effective treatment to fight bacteria in burn patients with open wounds. He further encourages expanded research but is excited by the promise of their first trial.
Apple cider vinegar commonly ranges in acidity levels from 2.5 percent to 3.0 percent in strength. When applying to areas affected by folliculitis, it is important to reduce its concentration. For the vinegar pack, mix 1 tablespoon of vinegar and ½ cup of water together. Dip cotton balls into the mixture. Apply to affected areas for 20 minutes, twice a day. You should start to see results within a few days, but it may take a week or more for some tough cases.
2. Tea Tree Oil
Known for its ability to fight bacteria and fungi, tea tree oil can be easily added to your favorite shampoo and body wash. This is particularly helpful for recurrent folliculitis as it is shown to be effective against bacteria that occur on the skin, including staph and most gram-negative bacteria. Plus it demonstrates great antifungal properties. (10, 11)
Before using, do a small test patch in an inconspicuous area as tea tree oil can cause an adverse reaction for some people. (11) If you don’t react to the test, mix 4 to 5 drops of tea tree oil with your favorite shampoo or body wash for each shower. Massage in well, allow to sit on your skin or hair for five minutes or so, and rinse well. This is a great option for those with recurring outbreaks — keep tea tree oil in your shower.
Known for its anti-inflammatory, antimicrobial and antioxidant properties, there is growing evidence that shows turmeric is effective for treating a variety of dermatologic diseases according to a systematic review published in the journal Phytotherapy Research. Researchers looked at results of 18 studies and found that 10 studies showed significant improvement in skin disease severity with turmeric/curcumin treatment. (12)
When fighting a folliculitis outbreak, take 600 milligrams three times a day of a high-quality turmeric supplement. Make sure you select one that contains black pepper or piperine as it increases turmeric’s absorption.
Topically, a turmeric paste may help fight an infection. But — be warned — the bright yellow tone of the turmeric may stain your skin for a couple of days. Mix a ½ teaspoon of turmeric powder with either coconut oil, or just a bit of water, to form a paste. Spread gently over the affected areas and cover with a bandage overnight. Reapply as necessary until the symptoms abate.
4. Witch Hazel
Used for generations for skin ailments, witch hazel is safe and effective for a myriad of hair and skin conditions, including folliculitis. Witch hazel fights bacteria while soothing irritation, including itching and inflammation, according to a study published in the International Journal of Trichology. (13) Apply witch hazel with a sterile cotton pad on and around the bumps and pimples. For the scalp, mix several drops of witch hazel into your shampoo and your conditioner and then wash, condition and style normally.
5. Grapefruit Seed Oil and Geranium Oil
According to a study published in the journal Burns, grapefruit seed extract and geranium oil, when used together, fight staph and MRSA. The study conducted by researchers from the Department of Biological Sciences at the Manchester Metropolitan University tested a variety of essential oils, including patchouli, tea tree, geranium, lavender, and grapefruit seed oil, to determine their antibacterial activity against the three different strains of staph. (14)
In addition to the geranium and grapefruit seed oil combination, researchers found geranium oil and tea tree oil most effective against methicillin-sensitive S. Auerus. For either combination, mix the oils half and half, and apply to the affected areas, covering with gauze overnight. Repeat for several days until the infection is gone.
6. Neem Oil
Because of its powerful antiseptic and antifungal properties, neem oil may rid the skin of bacteria and certain fungal infections, including Candida albicans, while reducing redness and inflammation. It may even help to prevent scars. In a study published in the Brazilian Journal of Microbiology, researchers praise the antifungal effect of neem at a 20 percent concentration. (15, 16)
To relieve a bacterial or fungal infection on the skin or scalp, mix 3 drops of neem oil to 1 tablespoon of coconut oil or almond oil. Apply to affected areas and massage gently into surrounding areas to help kill any surface level infection. Leave on overnight, if possible, or at least six to eight hours. Neem oil can also be applied directly to infected areas, but use it with caution the first time to make sure you don’t have an adverse reaction.
Folliculitis is not a fatal disease; however, recurrent infections can spread causing a widespread outbreak. Boils may develop under the skin and permanent skin damage is possible. This can include scarring, dark spots and permanent hair loss.
Treating underlying conditions and consulting with your physician about any medications that could be the root cause is important. Talk to your doctor first before stopping any prescribed medications.
- Folliculitis is a common skin condition that can be caused by bacterial, viral, fungal or parasitic infections, as well as shaving too close, using a hot tub and wearing tight clothing.
- It often presents as pinkish-red or white pus-filled bumps that itch intensely.
- Left untreated, folliculitis can cause permanent skin damage including scarring, dark spots and permanent hair loss.
- Many types can be treated effectively with self-care, but some types may require medical intervention if the root cause is due to medications or other treatments.
- Treatment needs to be focused on the root cause; bacterial, fungal, parasitic and viral infections are treated differently. Your physician may swab affected areas to determine the best course of treatment.
- Home remedies may be effective at treating certain types of folliculitis and help to relieve the inflammation, itching, overall discomfort and speed healing.
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