Folliculitis: Staph and Irritated Hair Follicles

What is folliculitis?

Folliculitis is a common skin condition in which hair follicles become inflamed. It’s often caused by an infection with bacteria, and the usual culprit is Staphylococcus aureus, or staph.¹ Viruses, fungi, some medicines and physical injury to the skin can cause it too.¹

Hair follicles are protected by healthy skin. When they’re damaged by shaving, friction or heat, germs can get in more easily and start an infection.² Because hair follicles cover most of your body, it can show up almost anywhere hair grows. Most cases are mild, but it’s worth knowing the signs that it’s getting worse.

What it looks like

Folliculitis often looks like a sudden acne breakout.² Common signs include:¹

• Clusters of small red bumps or pimples around hair follicles
• Pus-filled blisters that break open and crust over
• Itchy, burning skin
• Painful, tender skin

Each spot may have a red ring around it, a sign of infection.² Because it looks so much like acne, it’s easy to mistake one for the other, which is one reason a doctor’s look can help.² If a bump grows into a larger, deeper, painful lump, it may have become a boil. Our guide to boils, pimples and cysts explains the differences.

Common types and causes

Several kinds of folliculitis look alike but have different causes:¹

• Bacterial folliculitis: itchy, pus-filled bumps caused when follicles are infected, usually with staph.
• Hot tub rash: round, itchy bumps caused by Pseudomonas bacteria in hot tubs or heated pools that aren’t well maintained. It usually shows up a day or two after exposure.
• Razor bumps: irritation from ingrown hairs after close shaving, rather than an infection.
• Sycosis barbae: a type that affects people who shave.
• Pityrosporum folliculitis: itchy, pus-filled bumps caused by a yeast, most often on the back and chest.

Hot tub rash tends to be worse where a swimsuit held water against the skin, and mild cases often clear up on their own within a few days.³

Who is more likely to get it?

You’re more likely to get folliculitis if you:¹²

• Shave, wax or pluck hair
• Often wear tight clothing, or clothes that trap heat and sweat
• Soak in hot tubs, whirlpools or pools that aren’t well maintained
• Have diabetes or another condition that lowers your resistance to infection
• Use certain skin products or take certain medicines

Athletes and gym-goers often have several of these at once: sweat, tight gear and shared spaces. See staph at the gym for tips.

Habits that help

These steps from dermatologists and the CDC can lower your chances of folliculitis, or of it coming back:¹²³

• Wash your skin regularly, and change out of sweaty clothes soon after exercise.
• Wear loose clothing in hot, humid weather.
• If shaving caused it, dermatologists suggest stopping shaving or waxing for about 30 days to let follicles heal.
• If you can’t stop shaving, shave with care, and ask a dermatologist about technique.
• Use only hot tubs and heated pools that are kept clean and properly treated.
• After a hot tub, remove your swimsuit, shower with soap, and wash the swimsuit.
• If you own a hot tub, test the water regularly with test strips to keep disinfectant and pH levels in the range the CDC recommends.

For comfort, dermatologists suggest a warm compress on the area for 15 to 20 minutes, three or four times a day.² That soothes the skin, but it isn’t a substitute for a doctor if the bumps are spreading or getting worse. Try not to scratch or pick at the bumps, since that breaks the skin and gives bacteria another way in.

When to see a doctor

Mild folliculitis often settles down, but see a doctor or dermatologist if:¹

• The rash is widespread
• Symptoms don’t go away after a week or two
• You notice a sudden increase in redness or pain
• You have a fever or chills
• Bumps turn into larger, deep, painful lumps, or keep coming back

A dermatologist can confirm what kind of folliculitis you have, decide whether you need medicine, and help you plan around triggers you can’t avoid, such as shaving for work.² Folliculitis that keeps returning can lead to scarring or permanent hair loss in the area, so it’s worth treating properly.¹ If you have diabetes or a weakened immune system, check in sooner. Get urgent care for fever with spreading redness or feeling very unwell.