Folliculitis

Folliculitis is an inflammatory condition of the hair follicles, presenting as small red bumps or pustules around follicles, often itchy or tender. It can occur anywhere hair grows but commonly affects the beard area, scalp, axillae, groin, and legs.

Most cases are caused by bacterial infection, most often Staphylococcus aureus. Other infectious causes include Pseudomonas aeruginosa (hot tub folliculitis) and Malassezia yeast. Noninfectious irritation from shaving, friction, occlusion, or certain medications can produce a similar picture.

Clinical features range from superficial folliculitis with tiny pustules to deeper boils (furuncles). Diagnosis is usually clinical; cultures or skin scrapings may be used in persistent, recurrent, or severe cases to identify the organism and guide treatment.

Treatment depends on severity and cause. Mild disease improves with antiseptic cleansing, warm compresses, and topical antibiotics (mupirocin or clindamycin). More extensive disease or MRSA may require oral antibiotics (e.g., cephalexin or doxycycline). Hot tub folliculitis often resolves without antibiotics; severe cases may use fluoroquinolones. Fungal folliculitis requires antifungal therapy. If a collection forms, drainage may be needed.

Prevention includes good hygiene, avoiding shared razors, keeping skin clean and dry, and treating underlying conditions. With appropriate management, most cases resolve, though recurrences can occur.