Folliculitis is a very common skin disorder seen in all kinds of people of all ages. It is a benign condition, which appears as numerous small red or pink little bumps around hair follicles on any part of the skin including the chest, back, arms, legs, buttocks, and cheeks. It may create very small pus bumps around hair follicles, or a pink to red or “chicken skin” appearance on the skin. Although it is primarily a skin condition of teenagers and younger adults, folliculitis is also seen in all ages.

Many people with folliculitis are unaware that the skin condition has a designated medical term or that it is treatable. In general, folliculitis is often cosmetically displeasing and otherwise medically harmless. Many cases of folliculitis may resolve spontaneously without any treatment. Folliculitis is frequently noted in otherwise healthy patients visiting physicians such as dermatologists for other conditions. Treatment may typically include one or a combination of antibacterial washes, antibiotics creams or lotions, and antibiotic pills.

Frequently Asked Questions About Folliculitis

Who gets Folliculitis?

Anyone can get folliculitis anywhere on the body where hair follicles are present. Humans have hair follicles on their entire body except on the palms and soles. Folliculitis is estimated to affect more 10­20% of people at some point in their lives. Certain groups of people are more prone to folliculitis. Diabetics and those with a compromised immune system like in HIV/AIDS, hepatitis, chronic illnesses, cancer, systemic chemotherapy, immunosuppressive drugs like prednisone, and those on biologic immune system modifying drugs like Remicade or Enbrel may be more prone to folliculitis.

What is the prognosis with Folliculitis?

The prognosis with folliculitis is very good. Overall, folliculitis tends to be an easily treated and curable skin condition. Commonly, it is a mild, benign, usually non­contagious, and self­limited skin condition. More widespread, atypical cases of folliculitis may be cosmetically disfiguring and psychologically distressing for the patient. Does folliculitis affect the entire body? The lesions in folliculitis most characteristically involve the chest, back, and legs. Other common locations include the face, neck, thighs and buttocks. Although possible, it is rare to have it all over the body. It does not affect the eyes, mouth, palms, or soles where there are no hair follicles.

What does Folliculitis look like?

Photos of folliculitis patients show very small, often pinpoint red or pink bumps at each hair follicles. These small pus bumps or dry red bumps are often scattered over an area. Often, 10­100 very small slightly smooth bumps are scattered in a body area like the back. Some of the bumps may be slightly red or have an accompanying light­red halo indicating inflammation. Sometimes, scratching off the top reveals a small trapped or coiled hair beneath the bump. Acne white heads called milia may also be in the same areas as folliculitis. Patients may complain of small red bumps and “acne” on their skin. What causes the small bumps in folliculitis? The bumps seem to arise from the inflammation at the small hair follicles. Sometimes there are common skin bacteria like staphylococcus or pseudomonas in the follicles. The upper skin layers may have some dilation of the small superficial blood vessels, thereby giving the skin a red or flushed appearance.

How is Folliculitis diagnosed?

The diagnosis of folliculitis is typically very straightforward and based on the skin appearance. In some cases, a small skin biopsy may be used to help the doctor confirm the diagnosis. Other times, a skin bacterial culture may be taken by a cotton tip applicator to assist in determining an infectious cause of the folliculitis. A few other medical conditions may look just like folliculitis and need to be examined more closely by a physician specializing in conditions of the skin called a dermatologist. What else could folliculitis look like? Other medical conditions can mimic folliculitis. Some possible look­alike skin conditions include keratosis pilaris, acne, milia (whiteheads), eczema, impetigo, atopic dermatitis, facial rosacea, contact dermatitis, fire ant bites, heat rash (miliaria), insect bites, sea bather’s eruption, or dry skin (xerosis).

Less common mimickers include chicken pox, herpes, pustular psoriasis, molluscum contagiosum, viral warts, Fox­Fordyce Disease, Graham­Little­Piccardi­Lasseur Syndrome, pruritic papular eruption of HIV disease, and erythema toxicum neonatorum. Folliculitis may also resemble uncommon skin conditions like lichen spinulosus, pityriasis rubra pilaris, phrynoderma (vitamin A deficiency), ulerythema oophryogenes, ichthyosis vulgaris, eruptive vellus hair cysts, ethromelanosis follicularis faciei et colli, keratosis follicularis (Darier Disease), Kyrle Disease, lichen nitidus, lichen spinulosus, perforating folliculitis, and trichostasis spinulosa.

What causes Folliculitis?

Folliculitis is a basic problem with inflammation of hair follicles. This inflammation may be caused by simple irritation, infections like bacteria and yeasts, or other non­infectious skin conditions.

What is hot tub Folliculitis or Jacuzzi Folliculitis?

Hot tub folliculitis is a very common inflammation of the hair follicles on the trunk. It is seen a few days to weeks after someone has been soaking in a hot tub or Jacuzzi. It is most common on the back. Hot tub folliculitis photos show scattered pinpoint, small red to purple bumps all over the back or trunk. These may be very itchy or have no symptoms at all. Typically, there is a history of sitting for 1­3 hours in a hot tub days prior to the start of the bumps. Hot tub folliculitis is thought to be caused by Pseudomonas bacteria, which frequently thrives in the hot temperatures of hot tubs. It is also called Pseudomonas folliculitis. Often, this type of folliculitis may clear on its own in a few days without treatment. Cases that do not clear spontaneously or with simple topical antibacterial washes are often treated with oral antibiotics like ciprofloxacin (Cipro), or levofloxacin ( Levaquin) for 5­14 days depending on the severity. The hot tub should be tested and possibly treated by trained pool and spa personnel for bacterial overgrowth. Affected patients may be more prone to recurrences in the future and should be cautious about hot tub use.

What is Pseudo Folliculitis Barbae?

Pseudofolliculitis barbae is a very common ingrown hair condition on the beard area (lower face and neck) of men. Typically, there are groups of 5­40 small red bumps on the beard area that may flare with repeat shaving. Pseudofolliculitis tends to be worse in darker skin or African skin. The repeat tiny cuts caused by overly close shaving create possible ingrown or trapped hairs. These trapped hairs may cause irritation and inflammation at the hair follicles. Generally, this condition is not caused by bacteria. Treatment goals include avoiding overly aggressive shaving, trial of the “bumps­free razor”, and antibacterial benzoyl peroxide shaving gels. Other treatment options include professional laser hair removal, electrolysis, electric razors, or cream depilatories like Neet or Nair.

Is Folliculitis curable?

Most cases of folliculitis are easily and fully curable. There are very uncommon, long­standing cases of folliculitis that may not be curable. Often these more resistant cases may be controlled with proper treatment and medication. It sometimes clears completely by itself without treatment. Prevented by good skin hygiene and proper shaving techniques.

Folliculitis at a Glance:

  • Very common, benign skin disorder
  • Looks like scattered, pinpoint red bumps
  • Affects all ages from babies to seniors
  • Most common in teens and young adults
  • Numerous, small smooth red little bumps around hair follicles
  • Most common on the chest, back, buttocks, and legs.
  • Creates a “goose bumps” or “chicken skin” appearance of the skin
  • Often seen in otherwise healthy patients
  • Easily curable in most cases
  • Frequently clears on its own without treatment
  • May require ongoing maintenance therapy
  • Often treated with antibacterial washes like benzoyl peroxide.
  • Resistant cases may need antibiotic pills to clear