Follikulitis

Follikulitis is an inflammation of one or more hair follicles. It most commonly results from infection with Staphylococcus aureus, but it can also be caused by fungal, viral, or noninfectious processes. Clinically, it presents as small, raised red bumps or pustules centered on hair follicles, often accompanied by itchiness or tenderness. Lesions are typically found on the beard area, scalp, arms, legs, buttocks, or groin and may crust or scab as they heal. Infected follicles can coalesce or form painful boils (furuncles) if the infection extends deeper.

Causes and types: Bacterial folliculitis is the most common form. Hot tub folliculitis is caused by Pseudomonas aeruginosa from inadequately disinfected water. Pseudofolliculitis barbae arises from shaving. Fungal folliculitis results from dermatophytes or Malassezia species; viral folliculitis can occur with certain infections. Immunosuppression increases susceptibility, and underlying skin conditions can contribute to recurrence.

Diagnosis: The diagnosis is usually clinical. Cultures or skin swabs may be used in persistent, recurrent, or severe cases to identify organisms and guide antibiotic therapy, and to distinguish folliculitis from other facial or skin conditions such as acne or deeper infections.

Treatment and management: Mild cases often improve with good hygiene, warm compresses, and topical antiseptics such as chlorhexidine. Topical antibiotics (for example mupirocin or clindamycin) may be used for limited disease. More extensive disease or infection with resistant organisms may require oral antibiotics active against Staphylococcus species (e.g., dicloxacillin or cephalexin); MRSA risk may necessitate doxycycline or trimethoprim-sulfamethoxazole. Fungal folliculitis requires antifungal therapy, and viral cases are managed supportively.

Prevention and prognosis: Most cases resolve within days to a couple of weeks with appropriate care. Recurrent folliculitis can occur; preventive measures include good hygiene, avoiding sharing towels or razors, proper shaving technique, and addressing underlying skin conditions. Proper water hygiene in venues such as hot tubs can reduce risk.