The skin is the first line of defense of our body against infection. It is an indicator of how well you take care of yourself.
However, environmental factors that could cause bacterial infection in the skin may be inevitable as we are always exposed to the outside world. Hair somehow protects us against this invasion but as they perform their function, they may be jeopardized.
At some point, you may have experienced having red bumps over an area of your body which is covered with hair. This red bumps that look like a rash and is rooted from your hair follicles are called folliculitis.
It is an infection of the hair follicles that is usually seen on individuals postpubertal stage (though it can affect individual of any ages). It could be found on hairy areas of the body but it is most common on the scalp, face, groin, and thigh areas. It could also be filled with pus, is itchy and somewhat uncomfortable and embarrassing. 
Most folliculitis is benign and resolves on its own in a week or two even without any medical treatment. But there are also some cases that it gets infected and causes a more serious condition that needs prompt intervention especially if it’s recurring, deep and grossly infected.
Picture 1: Hair Follicle
Image source: www.webmd.com
Causes of Folliculitis
Though folliculitis may sound as a very simple condition, there are a lot of factors that can cause it.
- Physical injury, cut or scrape on the skin – serves as a portal of entry for different types of bacteria.
- Staphylococcus aureus (most common) – This is a group of bacteria that is commonly found on the skin but do not cause any harm. It could only penetrate and cause infection once there is a physical injury on the skin where it can be introduced.
- Hyperhidrosis – excessive sweating. We all know that bacteria tend to thrive on wet environments.
- Friction – from tight clothing or from shaving 
- Fungus – for persons who have undergone antibiotic therapy. The fungus present in our body sees the opportunity to cause an infection since the antibiotic therapy might as well attack other harmless bacteria of the body. 
- Pseudomonas aeruginosa – type of bacteria that can be found in hot tub facilities especially if the facility is not properly maintained or cleaned
- Chemical agents (like make up, motor oil, cocoa butter or tar) – irritate or block the follicles
- Long term antibiotic or steroid therapy
- Poor hygiene
- Obesity – more susceptible to folliculitis 
- Skin conditions like dermatitis or acne that can aggravate the folliculitis
- Preexisting medical conditions that make the immune system suppressed – conditions include but are not limited to HIV/AIDS, diabetes mellitus (either Type I or Type II), organ transplantation, leukemia, or cancer 
Picture 2: Infected Hair Follicle
Image source : www.iii.x-x.us
Is Folliculitis Contagious?
Most cases of folliculitis are not contagious but there are also severe cases that can be transferred from one person to another. Direct skin-to-skin contact, unsanitized hot tubs, shared razors and personal items, and poor personal hygiene are factors that could transfer the disease from one person to another.
Though it may occur in each and every person, there are just some that are more susceptible in acquiring it because of their overall health conditions .
Symptoms may vary depending on the type of folliculitis.
Folliculitis has two types:
- Superficial folliculitis
- Deep folliculitis.
Below, the symptoms will be presented in a manner that the difference between these two will be tackled.
1. Superficial Folliculitis
As the name implies, it affects the superficial or the upper part of the hair follicles and may present as follows:
- Singly or in clusters of small red bumps that can be filled with pus at times around the follicles
- When some of the bumps filled with pus breaks open, it will then crust over.
- Inflammation and redness around the affected skin
- Uncomfortable itchiness and tenderness
2. Deep Folliculitis
Unlike the superficial folliculitis that affects the upper part of the hair follicles, the deep type affects the whole hair follicle and starts deep in the skin and may present as follows:
- Swollen large bump or mass
- When the mass breaks open, it also crusts over as how the superficial type will be.
- Possible deep and dark scars will be left once the infection resolves. 
Picture 3: Superficial versus Deep Folliculitis
Image source : www.riversideonline.com
There is no specific test to diagnose folliculitis. The diagnosis is usually based on the gross presentation of the bumps or masses on the hair follicles but in rare occasions, doctors may advice you to have the pus from your folliculitis cultured to identify the kind of bacteria that caused the infection. To check for fungal cause, a sample of hair follicle might be pulled out and viewed under the microscope.  Also see Fungal Rash
Picture 1 : Folliculitis on buttocks
Image source :dermnetnz.org
Picture 2 : Folliculitis on eye (lower eyelid)
Image source : Dermnet
Picture 3 : Folliculitis on face
Image source : Dermnet
Picture 4 : Folliculitis on thigh and groin area
Image source : Samuel Freire da Silva, M.D., Atlasdermatologico
How To get rid of Folliculitis
Some treatment for folliculitis can also be ways to prevent it since there are occasions that the folliculitis has bouts of recurrences.
- Apply warm compress over the affected area to sooth the itch and pain. Warm compress will also help to drain the pus.
- Medications. Use of medications should have a go signal from your doctor since folliculitis can be caused by bacteria or fungus that has a huge difference on what medications to use.
- Antibiotics – for folliculitis that is caused by bacteria. It can be given orally, topically or combination of both depending on the extent of infection.
- Steroids – may be given orally or topically but is used in the shortest time possible as it may pose great side effects. Steroids help in addressing the itch and accompanying inflammation.
- Antihistamines – used in place of steroids on persons with HIV/AIDS as usage of steroids will further suppress their immune systems. 
- The affected area may be soaked in a tub filled with diluted white vinegar. To make the diluted white vinegar solution, you must add 1 part of vinegar to 4 parts water. 
- Having proper hygiene is the most effective treatment that a person can do.
- Take a bath everyday.
- Avoid sharing your personal items like towels and washcloth.
- When shaving, it is better to use shaving creams to prevent any nicks and bumps on your skin. You also need to regularly replace your shaver. Depilatory creams are also advisable but its use should be limited to only once or twice a week.
- Avoid using constrictive clothing.
- As much as possible, refrain from using public hot tubs.
- Keep your skin well hydrated.
- Use gentle skin care products for your face and body as much as possible.
Overall, the treatment and prevention for folliculitis are not that tedious. Aside from the medications, simple home remedies may be of great help for your comfort. Having the proper hygiene is also the key to keep folliculitis at bay.
But bear in mind that you need to schedule an appointment with your doctor if your folliculitis is accompanied by fever, if it is not responding to medications, and if instead of improving, its appearance worsens. There might be more to it than meets the eye and a professional help from your doctor will get you through it. [12, 13, 14, 15]