Folliculitis, boils and carbuncles, acute paronychia (infection bordering the nail) and whitlows are most commonly caused by staphylococcal infection. 

Risk factors for folliculitis, boils and carbuncles include nasal carriage of S. aureus; existing skin conditions, such as dermatitis; immunosuppression; obesity; and malnutrition. In addition, factors such as poor hygiene, wax epilation, shaving and topical corticosteroids can encourage the development of folliculitis.

Folliculitis can be the result of superficial infection of hair follicles with S. aureus, but can also be the result of, or aggravated by, irritation due to ingrowing hairs or occlusion caused by tight clothing or greasy emollients. 

Folliculitis is usually a mild, self-limiting condition but it can be recurrent and distressing for the patient. Patients present with multiple small papules and pustules around hair follicles, although the central hair may not always be visible. So-called ‘hot-tub folliculitis’ is caused by Pseudomonas aeruginosa, commonly found in contaminated, poorly maintained whirlpools, hot tubs, water slides etc. The pustules or papules typically appear in sites covered by bathing suits eight to 48 hours after bathing. 

Treatment

Management of aggravating factors is the first step in treatment. This could include removal of tight clothing; occlusive dressings; or use of heavy, greasy emollients. For shaving-related folliculitis, advise patients to stop shaving or shave less closely – aiming to leave 1mm of stubble – and shave in direction of hair growth. 

Daily use of an antiseptic wash containing triclosan, chlorhexidine or benzalkonium chloride, should also be recommended. Antiseptic-emollient products for topical application and washing and antiseptic bath additives are also recommended for use on the face or where skin is dry or inflamed. 

If the infection does not settle or appears to be deep, tender and inflamed the patient should be referred to a GP.