Folliculitis is inflammation of hair follicles, most often from Staphylococcus aureus, but also from Pseudomonas in hot tubs, from yeast, or from friction and shaving. It shows as small pimples centered on hairs and is usually mild.
Key symptoms
- Small itchy or tender bumps and pustules
- Common on the beard area, scalp, buttocks, thighs and legs
- Rash after shaving, waxing or wearing tight clothing
- Rash 1 to 2 days after using a hot tub
What you find on exam
- Small papules and pustules, each centered on a hair follicle
- Look for deeper boils (furuncles) or a cluster of them (carbuncle)
- Hot tub folliculitis: pustules mostly in areas covered by a swimsuit
- Ingrown hairs in the beard area suggest pseudofolliculitis
Tests
- Usually a clinical diagnosis
- Bacterial culture of a pustule if recurrent, severe or not responding
- KOH prep if yeast (Malassezia) folliculitis is suspected
Treatment basics
- Mild: warm compresses and antibacterial washes such as chlorhexidine or benzoyl peroxide
- Topical mupirocin or clindamycin for localized bacterial folliculitis
- Oral antibiotics such as cephalexin or doxycycline for extensive disease
- Remove the cause: pause shaving, wear loose clothing, keep hot tubs properly treated
- Recurrent staph: decolonization with nasal mupirocin and chlorhexidine washes
Red flags
- Painful, fluctuant boils that need drainage
- Spreading redness, fever or signs of cellulitis
- Recurrent or widespread disease (check for diabetes or immunosuppression)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.