Folliculitis: Causes, Symptoms & Treatment

Folliculitis is inflammation of a hair follicle that causes small red bumps, itching, and sometimes pus-filled blisters on the skin. It often develops after shaving or from ingrown hairs, but it can also result from bacterial or fungal infections.

Folliculitis commonly affects areas such as the buttocks, legs, groin, face, scalp, and armpits. Symptoms may improve on their own, but in some cases the condition can worsen and form a painful boil.

Diagnosis of folliculitis is usually made through a skin exam, and treatment depends on the cause and severity. Options may include proper hygiene, medicated ointments, oral antibiotics, antifungal shampoos, or minor procedures for deeper infections.

Common symptoms

The main symptoms of folliculitis are:

• Red bumps that look like acne;

• Small, pus-filled blisters at the base of the hair;

• Itching in the area;

• Pain and tenderness in the area;

• Redness and swelling in the area.

The small red bumps usually appear close to each other and can affect areas with hair, such as the face, arms, armpits, legs, buttocks, or groin.

Folliculitis symptoms usually improve within a few days even without treatment. However, in some cases this condition can worsen and lead to a boil, which is an infection that causes a painful, pus-filled lump, redness, warmth in the area, or pain.

Confirming a diagnosis

Folliculitis is diagnosed by examining the skin. Your primary care provider or a dermatologist can confirm the diagnosis with a physical exam to ensure the most appropriate treatment.

Different types

According to the location, folliculitis can be classified into the following types:

• Folliculitis in the groin: wax hair removal or shaving can cause ingrown hairs, increasing the risk of this type of folliculitis. Wearing tight clothing can also increase friction, heat, and moisture in the area, which may promote bacterial infection and folliculitis;

• Folliculitis on the scalp: can be caused by fungi or bacteria and may occur in people who frequently wear wigs, caps, hats, or helmets. This type of folliculitis is marked by small, pus-filled bumps that itch and may be painful;

• Folliculitis on the buttocks: is common in all genders and is caused by bacteria, leading to small, red, painful bumps filled with pus;

• Genital folliculitis: can be caused by hair removal in this area because, in some cases, the hair cannot grow outward and instead grows under the skin, causing inflammation;

• Folliculitis on the legs: can develop after hair removal with razors or wax, or from infections caused by bacteria, fungi, or viruses;

• Folliculitis in the armpits: can occur in all genders and is usually caused by waxing or shaving, leading to itching and painful, red, pus-filled bumps;

• Folliculitis on the face: can be caused by the use of razors or depilatory wax, affecting the entire face and the beard area.

In addition, folliculitis can also appear on areas such as the back, shoulders, arms, and neck, and may be caused by fungi or sun exposure.

Possible causes

Folliculitis usually happens when fungi, viruses, mites, or bacteria multiply on the skin around scalp hair or body hair, triggering inflammation. 

Some factors that may increase the risk of developing folliculitis include:

• Shaving or waxing frequently;

• Wearing tight clothing;

• Frequent use of helmets, hats, wigs, or tall boots;

• Having dermatitis or acne;

• Poor skin or hair hygiene;

• Frequently using bandages or adhesive tapes over areas with hair;

• Using medications such as antibiotics, lithium, or cyclosporine for long periods.

According to the Centers for Disease Control and Prevention (CDC), exposure to contaminated hot tub or spa water can cause “hot tub rash,” also known as Pseudomonas folliculitis.

In addition, people with conditions such as diabetes, obesity, or HIV are at higher risk of developing folliculitis.

Treatment options

Treatment for folliculitis may include:

1. Proper hygiene

In mild cases of folliculitis, proper hygiene of the skin and scalp, using soap, shampoos, and warm water, can resolve the condition within 7 to 10 days.

2. Ointments

Some ointments such as a triple-antibiotic ointment (bacitracin, neomycin, and polymyxin B), mupirocin, and clindamycin may be recommended to fight bacteria and relieve folliculitis symptoms, such as itching and pain in the affected area.

For folliculitis caused by fungi, a healthcare provider may prescribe topical antifungal medications such as ketoconazole.

3. Oral antibiotics

When ointments are not effective in treating folliculitis, antibiotics such as cephalexin, ampicillin, ciprofloxacin, or dicloxacillin may be prescribed by a healthcare provider to help fight bacterial infection.

4. Shampoos

Frequent washing of the hair with anti-dandruff shampoos containing ketoconazole or ciclopirox olamine, for example, may be recommended mainly for the treatment of folliculitis on the scalp.

5. Soaps

Local hygiene with antiseptic soaps and warm water may be recommended for the treatment of folliculitis on the face, beard, legs, genitals, and groin, for example.

6. Surgeries

In cases of deeper folliculitis or boils, a healthcare provider may perform a minor procedure to drain excess pus, relieving symptoms and helping with healing.

Care tips

According to the American Academy of Dermatology (AAD), shaving is a common cause of folliculitis, and shaving more carefully may help lower the risk of flare-ups.

Some measures that can help treat and prevent folliculitis include:

• Applying a warm compress to the affected area to reduce itching;

• Showering with mild soap immediately after using a pool, hot tub, or sauna;

• Avoiding scratching or picking at the bumps;

• Considering laser or pulsed-light hair removal;

• Avoiding creams, perfumes, or other irritating products on the lesions;

• Using an electric shaver instead of razors;

• Avoiding frequent use of hats, helmets, wigs, or caps;

• Wearing looser clothing.

If folliculitis symptoms do not improve after 2 weeks, it is recommended to follow up with your primary care provider or a dermatologist so that other treatments can be considered.