Folliculitis: definition, causes and treatment

By Cristiano Antonino On May 16, 2023

Folliculitis is an inflammation of the hair follicles, a formation in the dermis consisting of the hair and its sheaths

Folliculitis, in its severe form, can cause permanent hair loss and leave spots or scars on the skin.

During a specialist examination, the dermatologist may request in-depth tests for a specific diagnosis of the type of folliculitis present.

There are in fact two forms of folliculitis, one superficial and one deep, and the causes are different

Generally, the mildest and most frequent cases tend to resolve on their own and do not require therapy or treatment. They do not result in complications or scarring.

In more severe cases, however, folliculitis can degenerate into furunculosis, an infection that causes the formation of scars or dark spots and, in some cases, even the permanent loss of the hair follicle.

For this type of manifestation, pharmacological treatment is necessary.

Causes of folliculitis

Folliculitis has multifactorial origins, but at the root is usually a contamination (commonly by Staphylococcus aureus) that, as a result of rubbing, excessive sweating or the presence of inflammatory diseases such as acne, abrasions and excoriations, proliferates in an uncontrolled manner, leading to infection of the follicle.

Infections are therefore the main triggering factor. Besides bacteria, infectious folliculitis can also be caused by fungi (e.g. Candida albicans, mycetes such as Malassezia and Trichophyton rubrum) and viruses (e.g. Herpes simplex).

Risk elements that may contribute to an increased likelihood of infection include:

Immunodepression
Diabetes mellitus
Obesity
Insect bites or stings
State of obesity

Symptoms and diagnosis of folliculitis

Folliculitis usually manifests itself with the appearance of superficial pustules or nodules around a hair follicle, resulting in mild pain, itching, or irritation.

Superficial folliculitis, the most common and least problematic, involves the appearance of red furuncles and/or small pus-filled pustules near the follicles, the size of which depends on the depth of the infection, accompanied by reddening of the skin and itching.

In cases of deeper folliculitis, on the other hand, there is pain and scarring.

During infection it is not uncommon to find scabs at the base of the follicle, which it is always preferable not to remove in order not to worsen the situation.

Diagnosis is only possible by consulting a specialist dermatologist or trichologist who will be able to indicate an appropriate therapy.

In some cases the doctor may decide to prescribe specific tests to identify the exact infective agent and modulate the therapy.

It is always a good idea to consult the specialist when

the infection spreads further or relapses occur;
in addition to the symptoms on the skin, a fever above 38°C appears;
the infected area becomes reddened, swollen and causes more or less intense itching or pain;
the signs of inflammation do not improve but continue to proliferate or recur.

Scalp folliculitis

A very annoying variant of folliculitis is scalp folliculitis.

In this condition, the hair follicles are infected by bacteria, viruses or fungi, which may result in a follicular pustule giving rise to decalvating folliculitis: the severe inflammation triggers a process in which the follicles tend to merge, so that hair sprouts from the same follicular ostium, around the scar areas.

The result is inflammation with the formation of scabs and, in some cases, hypersecretion of the sebaceous glands causing itching and pain on the scalp.

This localisation of folliculitis affects both men and women and takes time to heal.

Treatment involves the use of anti-inflammatory drugs together with the use of non-aggressive hair care products based on zinc, salicylic acid and ketoconazole, which are essential to control inflammation and balance the hydrolipidic balance for the health of the follicle itself.

In the most severe form (decalcifying folliculitis), the inflammation spreads to larger, surrounding areas. In men it can also occur in adolescence, while in women it usually appears after the age of 30.

How to prevent folliculitis

In order to prevent the appearance of folliculitis, certain behaviours can be adopted, such as avoiding wearing clothes that are too tight or made of rough fabrics: these can cause lesions that, if overinfected, can develop into superficial folliculitis.

Men should try to shave atraumatically, using an electric razor or a new razor blade for each shave and following the direction of the hair.

For women, the safest method of hair removal in this respect is depilatory cream or laser hair removal

In both cases, it is good to maintain a high level of skin hygiene by using non-aggressive products before and after depilation/epilation.

Finally, attention must be paid to the hygiene of the tubs and pools, where there must be a sufficient and balanced amount of chlorine to avoid ‘whirlpool folliculitis’, a dermatitis caused by the bacterium Pseudomonas Aeruginosa, which can appear on the whole body or on the areas in contact with the tub (buttocks and back of the legs).

How to treat folliculitis

Normally, folliculitis is superficial and therefore easy to treat, even with home treatments and natural remedies.

In fact, within a couple of weeks it tends to disappear on its own.

Non-pharmacological remedies include

the infection spreads further or relapses occur;
in addition to the symptoms on the skin, a fever above 38°C appears;
the infected area becomes reddened, swollen and causes more or less intense itching or pain;
the signs of inflammation do not improve but continue to proliferate or recur.

Treatments for superficial folliculitis

Superficial folliculitis is the most common form of folliculitis characterised by the appearance of red furuncles and/or small pus-filled pustules near the follicles and may cause itching or, more rarely, pain.

Cases of mild folliculitis often heal on their own, but it is advisable to proceed with thorough body hygiene using only mild, neutral soaps or an antibacterial soap.

Natural remedies are usually sufficient to accelerate healing from this type of folliculitis.

Treatments for infectious folliculitis

Infectious folliculitis is deeper than superficial folliculitis and can be triggered by different types of microorganisms, such as bacteria, viruses or fungi.

Therapy therefore varies depending on the triggering pathogen.

Pseudomonas folliculitis: these are generally self-limiting and do not always require pharmacological intervention if the patient has a competent immune system. Otherwise, specific antibiotics must be used.

Gram-negative bacterial folliculitis: occurs after prolonged antibiotic acne therapy and involves the use of antibiotics effective against Gram-negative micro-organisms by topical or oral route other than those previously used for acne treatment

Herpetic folliculitis: of viral origin, it is generally treated with antivirals such as valacyclovir, famciclovir, or acyclovir.

Fungal folliculitis: is treated with antifungals such as fluconazole and econazole, etc.

Treatments for non-infectious folliculitis

When the triggering causes of folliculitis are not of bacterial, fungal or viral origin, we speak of ‘non-infectious folliculitis’.

For instance, ‘petroleum’ or ‘oil’ folliculitis is an inflammation of hair follicles caused by exposure to petroleum-derived mineral oils.

Again, ‘shaving pseudofolliculitis’ is a type of folliculitis that occurs when hairs penetrate the skin before they even come out of the hair follicle.

This type of folliculitis normally requires topical or systemic therapy based on cortisone or any other soothing and anti-inflammatory natural nails.

Incidence of folliculitis

Folliculitis is a fairly common disorder that can occur at all ages in both men and women.

It can affect any skin area of the body that harbours hair, the exception being the palms of the hands and the soles of the feet (the only areas of the skin that are truly hairless).

However, the main location in men is the face due to the continuous stimulus given by shaving the beard.

In women, however, the most frequent sites of manifestation of the disease are the arms, legs and buttocks.

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