Folliculitis

Folliculitis can be the result of superficial infection of hair follicles with Staphylococcus 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. Nevertheless, it can be distressing for the patient and can be recurrent. 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, as this organism is commonly found in contaminated (i.e. poorly maintained) whirlpools, hot tubs and water slides. The pustules or papules typically appear in sites covered by bathing suits eight to 48 hours after bathing.

Management of aggravating factors is the first step. This could include removing tight clothing, occlusive dressings or heavy (greasy) emollients. For shaving-related folliculitis, advise patients to stop shaving or shave less closely (aim 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 be recommended.

Antiseptic-emollient products (e.g. the Dermol range) for topical application and washing and antiseptic bath additives (e.g. Oilatum Plus, Emulsiderm) are recommended for using on the face or where the skin is dry or inflamed. If the infection does not settle or appears to be deep (tender, inflamed), the patient should be referred to his/her GP.