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Health condition · Clinically reviewed

Folliculitis, from hot tub rash to sycosis barbae - and how to settle it.

Inflamed hair follicles are common. Getting the cause right - bacterial, fungal, Demodex, drug-induced or ingrowing hairs - is what makes treatment work.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE CKS, BAD and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice for bacterial, fungal, Demodex and drug-induced folliculitis.

Key facts

Folliculitis at a glance.

The essentials, in plain English - what folliculitis is, the main types and how it is treated in the UK today.

  • What it is

    Inflammation of the hair follicles - a very common condition producing papules and pustules centred on follicles.

  • Main causes

    Bacterial (Staph aureus, Pseudomonas), fungal (Malassezia, tinea), viral (HSV, HZV), parasitic (Demodex, scabies) and drug-induced.

  • Hot tub folliculitis

    A Pseudomonas rash after warm pools or spas with inadequate chlorination - usually settles on its own.

  • Malassezia folliculitis

    An itchy pustular rash on the trunk, back and shoulders - often mistaken for acne but antifungal-responsive.

  • Pseudofolliculitis barbae

    Ingrowing hairs from shaving - more common in Afro-textured hair; helped by shaving changes and laser hair removal.

  • When to refer

    Recurrent, deep or scarring folliculitis, MRSA, immunocompromise, or a suspected drug reaction warrant a specialist opinion.

Why this guide matters

The right cause, not the loudest cream.

Folliculitis is common, but many people cycle through creams that were never going to work for their cause. The three points below shape everything else on this page.

  • The cause dictates the treatment

    Bacterial, fungal, viral, parasitic and drug-induced folliculitis need very different plans - a swab or scraping saves months of guessing.

  • Friction and shaving matter

    A large share of chronic folliculitis is driven by shaving, tight clothing and occlusion, not just bacteria - habits are as important as prescriptions.

  • Recurrent disease deserves review

    Recurrent or scarring folliculitis is a signal to look for MRSA, immune drivers or a medicine cause and to get a dermatology opinion.

How the diagnosis is made

From first pustules to a clear plan.

The steps a UK GP or dermatologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Skin exam and pattern

    A structured look at where the papules and pustules sit - beard, scalp, trunk, buttocks or limbs - and whether they are follicle-centred.

  2. 02

    Assessing

    History for triggers

    Shaving, hot tubs and pools, occlusive clothing, oils and greases at work, recent antibiotics, steroids or new medicines.

  3. 03

    Assessing

    Assess depth and scarring

    Superficial pustular folliculitis behaves very differently from deep, scarring sycosis barbae or hidradenitis.

  4. 04

    Confirming

    Bacterial swab

    A swab for culture and sensitivity when the picture is bacterial, recurrent or not responding to first-line treatment. Screens for MRSA.

  5. 05

    Confirming

    Skin scrapings and KOH

    Scrapings with KOH microscopy for suspected fungal folliculitis or Demodex overgrowth. A biopsy is used selectively.

  6. 06

    Escalating

    Consider HIV and immunity

    Eosinophilic folliculitis, severe or unusually recurrent disease may prompt HIV testing and a look for other immune drivers.

  7. 07

    Escalating

    Dermatology referral

    Deep, scarring, chronic or drug-induced folliculitis, or when the diagnosis is uncertain, deserves a specialist opinion.

Typical timeline: a first visit to a settled plan in weeks, not months.

Symptoms

What folliculitis actually looks like.

Follicle-centred papules and pustules, itching, burning and tenderness in areas of shaving or friction - and the features that mean it is time to escalate.

  • Follicle-centred papules

    Small red bumps sitting directly on hair follicles - the defining feature of folliculitis.

  • Pustules with a central hair

    Tiny pus-filled spots each pierced by a hair shaft - classic on the beard, trunk and thighs.

  • Itching and burning

    Superficial folliculitis often itches or stings before it hurts - Malassezia and hot tub folliculitis are especially itchy.

  • Tender deep lesions

    Sore, deeper nodules point to sycosis barbae, MRSA or hidradenitis rather than simple superficial folliculitis.

  • Beard area involvement

    Recurrent pustules in the beard suggest sycosis barbae or pseudofolliculitis - shaving technique matters as much as antibiotics.

  • Trunk and back rash

    Widespread itchy monomorphic pustules on the back and shoulders in young adults - think Malassezia folliculitis.

  • Post-inflammatory marks

    Brown or grey pigmentation and small scars can follow deeper or picked lesions - especially in darker skin.

  • Red flag - fever or spreading redness

    Systemic symptoms, cellulitis or rapidly spreading disease need same-day medical review.

Treatment

How folliculitis is treated in the UK.

Hygiene and antibacterial washes first, targeted topicals next, then oral antibiotics, antifungals, ivermectin or laser hair removal where the cause demands it.

  • Hygiene and antibacterial washes

    Chlorhexidine or benzoyl peroxide washes, warm compresses and a break from shaving or friction settle many mild cases.

  • Topical antibiotic

    Mupirocin, fusidic acid or clindamycin for localised bacterial folliculitis - short courses to avoid resistance.

  • Topical antifungal

    Ketoconazole or clotrimazole for Malassezia folliculitis - often applied to the trunk and scalp for several weeks.

  • Benzoyl peroxide and retinoid

    Useful for mixed acneiform and folliculitic pictures - reduces keratin plugging and bacterial load.

  • Oral antibiotics

    Flucloxacillin for extensive Staph disease, doxycycline for rosacea-like patterns; low-dose long-term options for Malassezia when needed.

  • MRSA-directed therapy

    Specialist microbiology input, decolonisation and targeted antibiotics for confirmed methicillin-resistant Staph.

  • Demodex-directed therapy

    Topical ivermectin (Soolantra) and, in resistant cases, oral ivermectin - see also our facial flushing and redness guide.

  • Shaving changes and laser

    Modified shaving technique and specialist laser hair removal for pseudofolliculitis barbae and chronic beard folliculitis.

Related pathways

Deep-seated or recurrent axillary and groin lesions may be hidradenitis suppurativa rather than simple folliculitis, and Demodex overlap often sits alongside rosacea and facial flushing. For chronic beard and shaving-related disease, specialist laser hair removal can transform outcomes.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or dermatologist knows your skin and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE CKS. Folliculitis, boils and carbuncles.

  • British Association of Dermatologists (BAD). Patient information leaflets on folliculitis and pseudofolliculitis barbae.

  • Public Health England. MRSA and Staphylococcus aureus skin infection guidance.

  • MHRA and BNF. Isotretinoin, ivermectin and topical antibiotic monitoring guidance.

Red flags

When folliculitis needs urgent attention.

Most folliculitis is manageable in primary care. These are the situations that are not - and where a specialist opinion is needed.

  • Fever or systemic upset

    Folliculitis with fever, chills or feeling unwell may signal deeper infection or bacteraemia - seek same-day medical review.

  • Spreading redness or cellulitis

    A hot, red, expanding area around lesions can indicate cellulitis and needs urgent antibiotics.

  • Deep, scarring lesions

    Sycosis barbae, keloidal folliculitis of the scalp and severe hidradenitis need early specialist care to limit scarring.

  • MRSA suspicion

    Recurrent boils, household clusters or previous MRSA warrant a swab and specialist microbiology input.

  • Immunocompromise

    Diabetes, HIV, chemotherapy or long-term steroids raise the risk of unusual and severe folliculitis.

  • Drug-induced folliculitis

    A monomorphic acneiform eruption after starting EGFR inhibitors, steroids, lithium or ciclosporin needs a prescriber review, not just topical creams.

  • Eosinophilic folliculitis

    Very itchy sterile pustules in HIV or immunosuppressed patients - a marker for uncontrolled immune disease that needs specialist input.

  • Failed first-line treatment

    Folliculitis that has not settled after two to four weeks of appropriate treatment should be reassessed and swabbed.

  • Occupational exposure

    Oils, greases and coal tar at work can drive a chronic pattern - occupational health can help modify exposure.

Living with it

A treatable condition, with a clear plan.

Four things that make the biggest difference day to day - gentle antibacterial care, mindful shaving and clothing, care with hot tubs, and knowing when to escalate.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits kept up for weeks do more than a heroic few days that does not last.

  1. 01 Routine

    Gentle antibacterial care

    A daily chlorhexidine or benzoyl peroxide wash on affected areas is often more useful than a shelf full of products.

  2. 02 Friction

    Mind clothing and shaving

    Loose, breathable clothing, avoiding tight sportswear over damp skin, and a break from shaving during flares all help.

  3. 03 Water

    Be careful with hot tubs and pools

    Shower promptly after warm pools and spas; avoid ones that look poorly maintained - this prevents hot tub folliculitis.

  4. 04 Escalate

    Ask for a swab if it keeps coming back

    Recurrent folliculitis is a signal to swab, review medicines and consider a specialist opinion, not to keep repeating the same cream.

Frequently asked

Everything we get asked about folliculitis.

Quick answers on hot tub rash, Malassezia folliculitis, sycosis barbae and when to see a doctor.

  • What is folliculitis?

    Folliculitis is inflammation of the hair follicles. It usually shows up as small red papules and pus-filled spots centred on follicles. It can be caused by bacteria, fungi, viruses, parasites, ingrowing hairs, medicines or occupational exposures.

  • Is folliculitis contagious?

    Most simple folliculitis is not highly contagious, but Staph aureus and MRSA can spread between close contacts, especially in households or sports settings. Sharing razors, towels and unwashed sportswear increases the risk.

  • What is hot tub folliculitis?

    Hot tub folliculitis is a Pseudomonas rash that appears one to three days after using a warm pool, hot tub or spa with inadequate chlorination. Itchy red bumps and pustules appear on skin covered by the swimsuit and usually settle by themselves within a week or two.

  • How is Malassezia folliculitis different from acne?

    Malassezia folliculitis often looks like acne on the trunk, back and shoulders but is very itchy, monomorphic and does not respond well to typical acne creams. It is caused by yeast overgrowth in the follicle and responds to topical, and sometimes oral, antifungal treatment.

  • Why does folliculitis keep coming back on my beard?

    Recurrent beard folliculitis is usually sycosis barbae (deep Staph infection) or pseudofolliculitis barbae (ingrowing hairs from shaving). Swabbing, adjusting shaving technique, using antibacterial washes and, when needed, laser hair removal or antibiotics all have a role.

  • When should I see a doctor about folliculitis?

    See a clinician if lesions are deep, painful or scarring, if you feel unwell or feverish, if the rash spreads quickly, if you are immunocompromised, or if a rash appears after starting a new medicine such as an EGFR inhibitor or long-term steroid.

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