Folliculitis, Barber’s itch

Overview  

Folliculitis is a common skin condition caused by infected or inflamed hair follicles. It may look like acne and can be itchy and uncomfortable. Folliculitis can affect anyone and can be found in various areas with hair on the body, such as the face, arms, upper back, and lower legs.  

The location of the condition on the body can vary depending on the specific type of folliculitis. 

• Staphylococcus aureus folliculitis: This common form of folliculitis is caused by an infection of the hair follicle with Staphylococcus aureus bacteria. It presents as small red or white pus–filled pimples on the skin. Most cases resolve on their own within a few days, but severe or persistent cases may require medical treatment. 
• Pseudomonas aeruginosa folliculitis: This type of folliculitis is caused by the bacteria Pseudomonas aeruginosa, thriving in heated, moving water like hot tubs and whirlpools. It results in a rash similar to staphylococcal folliculitis and may be itchy. The rash usually fades on its own within a few days, but in rare cases, medical treatment may be necessary. 
• Malassezia folliculitis: Malassezia, a type of yeast normally found on the skin, can lead to an itchy condition resembling an acne breakout when it enters hair follicles. It primarily occurs on the upper chest and back and is aggravated by sweat. Using an antidandruff shampoo on the affected areas can be helpful. 
• Pseudofolliculitis barbae: This type typically affects the beard area. Shaving with a razor can cause trimmed hair edges to grow back into the skin, leading to irritation. It is more common in individuals with curly hair, especially Black men. Avoiding shaving or using trimmers can help, and if the problem persists, consulting a dermatologist is recommended to prevent scarring. 
• Sycosis barbae: This severe form of shaving–related folliculitis can cause potentially scarring large red pustules. Shaving should be avoided, and consultation with a dermatologist is essential for discussing treatment options. 
• Gram–negative folliculitis: Prolonged antibiotic use for acne can lead to this condition, where resistant bacteria grow and worsen the acne. Dermatological or medical intervention is necessary to treat this condition. 
• Boils (furuncles): Boils occur when hair follicles become deeply infected, resulting in red, tender, and painful lesions. They may require oral medications or procedures for resolution and can leave behind scars. 
• Carbuncles: Carbuncles form when multiple boils appear in one spot, combining infected hair follicles. They may necessitate oral medications or procedures to resolve the lesion. 
• Eosinophilic folliculitis: Eosinophilic folliculitis primarily affects individuals with a weakened immune system (immunosuppressed patients) and can also occur in babies. It is a non–infectious condition characterized by itchy pustules, commonly appearing on the shoulders, upper arms, neck, and forehead. While these pustules often resolve spontaneously, there is a possibility of recurrence. 

Mild cases usually get better on their own within a few days with simple self–care. However, more severe or recurring infections might require prescription medicine. If left untreated, serious infections can lead to permanent hair loss and scarring. So, it’s essential to take care of it to avoid complications. 

Symptoms 

The signs and symptoms of folliculitis include:  

• Clusters of small bumps or pimples around hair follicles  
• Pus–filled blisters that break open and crust over  
• Itchy, burning skin  
• Painful, tender skin  
• An inflamed bump  
• Superficial folliculitis can look like a pus–filled bump.  
• Round, itchy pimples that may eventually turn into tiny pus–filled blisters are the symptoms of tub folliculitis. Where the swimsuit presses water on the skin, the rash is probably going to be worse.  
• Curly beards can cause razor pimples. Another name for the disorder is pseudofolliculitis barbae. Inflammation results from shaved hairs that curl back into the skin.  
• A group of painful, pus–filled boils that unite to form an infected area under the skin is known as a carbuncle. 

If your folliculitis is widespread or the symptoms persist despite a week or two of self–care, it’s important to schedule an appointment with your healthcare provider. You might require prescription–strength antibiotics or antifungal medications to manage the condition effectively. Seek immediate medical attention if you notice signs of a spreading infection, such as a sudden increase in redness or pain, accompanied by fever, chills, and a feeling of being unwell (malaise). Timely attention in such situations can prevent complications and ensure appropriate treatment. 

Causes 

Folliculitis is often caused when bacteria, like Staphylococcus aureus (staph), infect hair follicles. But it can also be triggered by viruses, fungi, parasites, medications, or physical injury. Sometimes, the cause remains unknown. When hair follicles get damaged, they can be invaded by viruses, bacteria, and fungi, leading to folliculitis. It can appear as superficial folliculitis, affecting the upper part of the hair follicle and the skin around it, or as deep folliculitis, which affects more of the follicle or even the entire follicle. 

Risk factors  

Anyone can develop folliculitis, but certain factors can increase the risk of its occurrence. These risk factors include:  

• Frequently wearing attire that traps heat and moisture, such as rubber gloves or high boots.  
• Engaging in activities like soaking in inadequately maintained hot tubs, whirlpools, or public pools.  
• Causing damage to hair follicles due to practices like shaving, waxing, wearing tight clothing, or using hair styling techniques such as traction, wigs, and oils.  
• Using specific medications, including corticosteroid creams, prednisone, long–term antibiotic therapy for acne, and certain chemotherapy drugs.  
• Conditions like dermatitis or excessive sweating (hyperhidrosis). 
• Medical conditions such as diabetes, HIV/AIDS, or other conditions that weaken the body’s ability to fight infections.