Folliculitis: treatment, causes, symptoms and whether it is contagious

Treatment depends on the cause, and Patient.info says identifying it helps decide what will work. Most mild cases need no treatment and often clear within 7 to 10 days.

PCDS sets out management as steps for GPs: first deal with the causative factors, then treat infection if present, then look at shaving and other hair removal, and then consider other treatments. In practice that translates to the following.

• General measures: avoid things that aggravate it, take a break from hair removal until it settles, avoid tight clothes over the area, keep cool and exposed to fresh air, and do not share towels, flannels or razors (Patient.info).

• Mild cases: an emollient that contains an antibacterial agent, used as a soap substitute, may help clear it faster. If simple measures over a few days do not help, seek medical advice (Patient.info).

• Small areas: an antibiotic cream such as fusidic acid may be used (Patient.info). PCDS says mild bacterial cases may resolve without treatment or need only a topical antiseptic.

• More severe or widespread: a course of antibiotic tablets may be needed. PCDS says severe or recurrent cases may need antibiotics for 4 to 6 weeks.

• Yeast (Malassezia) folliculitis: PCDS describes ketoconazole cream or shampoo daily until things settle, then once or twice weekly to prevent relapse in people who relapse.

• Boils: the NHS suggests a warm, clean cloth held against the boil for 10 minutes 4 times a day, covering any leaking pus, and not picking, squeezing or piercing it. A GP may drain a boil or prescribe antibiotics.

Folliculitis means inflammation of one or more hair follicles, the small pockets in the skin from which hairs grow. PCDS says it can be superficial or deep and can affect any hair-bearing area of skin.

Because it is a pattern rather than one disease, it ranges from a few spots that settle in days to a long-term problem. Patient.info describes it as anything from a mild, short-lived condition to a severe long-term problem. Deeper infection of a follicle is called a furuncle (boil), and several joined together are a carbuncle.

Patient.info says folliculitis itself is not contagious. The exception is hot tub folliculitis, where others exposed to the same contaminated hot tub are likely to develop it as well.

If infection is the cause, Patient.info notes the bacteria or fungi can spread to other hair follicles on your own body, especially if you scratch the area or sweat heavily. PCDS adds that shaving can spread folliculitis of the beard area.

For boils, the NHS advises not sharing towels and not going to a swimming pool or gym until the boil has gone, because you could pass the infection on. It also advises washing towels and bedding at least once a week at a high temperature.

Patient.info describes a red bump where a follicle swells, sometimes filled with pus to form small, rounded yellow-red spots (pustules). The skin may crust, with a yellow or golden crust suggesting infection, and can feel painful, hot and itchy.

PCDS says superficial folliculitis usually shows as multiple small papules and pustules on a red base, each often pierced by a central hair. Deeper lesions are painful, red and often fluctuant nodules, which may drain pus.

It can occur wherever hair grows. Patient.info lists the buttocks, legs, back, chest, face and scalp as particularly common sites.

The cause and the best approach differ by type, which is why it helps to name the pattern.

Patient.info lists the main causes as infection, physical irritation from shaving or friction, chemical irritation, blockage of the follicle (for example by dead skin cells or thick creams), excessive sweating and steroid creams. Inflammatory skin conditions are an uncommon cause.

PCDS gives practical examples: shaving and other forms of hair removal, emollients and topical steroids used for conditions such as eczema, sitting for long periods, working in hot environments in protective clothing, and medicines including corticosteroids, androgens and lithium. Patient.info also says that long-term antibiotic use for acne can lead to gram-negative folliculitis.

For boils, the NHS says you may be more likely to get them if you have a condition affecting the immune system such as diabetes or HIV, eczema, take steroids, are living with obesity or malnutrition, or have been in close contact with someone who has boils.

It varies by type. Patient.info says mild cases often clear without treatment within 7 to 10 days, and hot tub folliculitis usually settles within 2 weeks. PCDS says Pseudomonas folliculitis from contaminated water usually clears spontaneously in 2 to 10 days.

Some forms last longer. Patient.info says recurrent folliculitis can become chronic if gaps between episodes shorten, and PCDS says persistent or recurrent deep lesions may lead to scarring and permanent hair loss. The NHS advises seeing a GP if a boil has not improved after 2 weeks of self-care.

PCDS says the only certain cure for shaving-related folliculitis is to stop shaving for around 3 months or longer, although this is not always possible. If you have to shave, its advice is to aim for a stubble length of about 1 mm, use an electric razor if possible, or a single blade in the direction of hair growth without stretching the skin, and shave every second day rather than daily if possible.

Patient.info suggests using clean, sharp razors with shaving soap, gel or foam, trying hair removal methods other than shaving and exfoliating regularly. It does not recommend routine antiseptic washes, as they can make skin sore and dry.

See a GP if simple measures do not help within a few days, or if you have a boil that has lasted 2 weeks despite self-care, keep getting boils or have a group of boils (carbuncle), according to the NHS and Patient.info.

The NHS says to ask for an urgent GP appointment or call NHS 111 if you have a boil and any of the following.

• It is on your face.

• The skin around it feels hot, painful and swollen.

• You feel hot, cold or shivery.

• You have a weakened immune system, for example from steroid treatment or a condition such as diabetes.

• Patient.info also advises seeking medical advice if infection is spreading deeper or onto surrounding skin, which may be cellulitis.

PCDS describes tests a GP may consider for recurrent infection: swabs of the pustules, swabs from the nose to look for staphylococcal carriage (treated with mupirocin nasal ointment if positive), and for recurrent boils a blood screen including full blood count and fasting glucose. It also mentions testing for the Panton-Valentine leukocidin (PVL) strain of staph when lesions are very painful or necrotic, in which case discussion with microbiology and local dermatologists is advised.

It also says tinea (fungal infection) of the beard can be mistaken for bacterial folliculitis, which is why scrapings may be sent for mycology.

Most folliculitis needs only self-care, advice from a pharmacist or one GP appointment. PCDS describes management as largely a primary care matter, with specialist input for recurrent or PVL-positive disease and for scarring forms such as folliculitis decalvans.

A private dermatology appointment may suit persistent, scarring or hard-to-diagnose folliculitis, particularly where an NHS outpatient wait is long. The assessment is broadly similar: examination, swabs, and review of triggers such as shaving habits, creams and medicines. Hot tub or shaving-related folliculitis rarely needs a specialist.