Folliculitis

Thanks to my dear little four-year-old niece, who pretty much lived in her plastic outdoor swimming pool in Auckland over this hot summer, I know all about ‘hot tub folliculitis’. My poor brother was horrified to find out that their family swimming pool had grown a lovely culture of Pseudomonas aeruginosa bacteria, and infected Baddy (as she is affectionately known due to her enthusiasm for mischief), turning the skin on her arms and legs into a collection of small, red, itchy bumps. This type of folliculitis can be quite common when it is muggy and hot as these are the perfect conditions for bacteria to thrive in warm water – they love backyard swimming pools!

Folliculitis is the name given to a skin condition that happens when the hair follicles get inflamed. It starts as small, red bumps at the bottom of a hair follicle, and these bumps can turn into white-headed pimples. The infection can spread and turn into crusty sores and the skin can feel very itchy and sore. Sometimes infection of the hair follicle will cause a large swollen bump or mass. These bumps are called boils or if there is a cluster it is called a carbuncle. They are usually quite painful as the infection builds up and puts pressure on the nerve endings. Folliculitis can be superficial, involving only part of the hair follicle, or deep, where the infection is more severe and involves the entire follicle. If the skin infection is deeper under the skin, a person may feel feverish or unwell. Folliculitis can happen anywhere on the body with hair follicles (there are no follicles on the palms, soles of the feet, lips or mucous membranes).

There are several different types of folliculitis depending on the type of bacteria, virus or fungus that causes the infection. Sometimes it can be caused by irritation from chemicals or some skin conditions. ‘Hot tub rash’ or ‘spa rash’ is usually caused by Pseudomonas bacteria found in spa pools and heated swimming pools where chlorine and pH levels aren’t well regulated. The red, round itchy bumps pop up one to two days after exposure to the bacteria. ‘Razor bumps’ and ‘barber’s itch’ are frequently caused by shaving causing skin irritation and ingrown hairs along with infection with Staphylococcus aureus bacteria. Staphylococcus bacteria lives on the skin all the time but can cause problems if it gets into the body through a cut or wound. Men with curly hair that shave too close to the skin often suffer from this type of folliculitis on the face and neck.

Treatment of folliculitis depends on the cause – whether it is bacterial, viral, fungal or an irritation. For mild infections, an antiseptic wash may be all that is needed. If more severe, treatment may involve antibiotic ointments or tablets. Some persistent boils may need to be drained by a doctor. If folliculitis is caused by shaving, taking a break from shaving is worthwhile. Keeping the skin cool and free of sweat or friction can help.

It is important to get checked out by a doctor if the folliculitis is in a large area or many parts of the body are affected. If the rash doesn’t go away or if it looks like it isn’t improving after a few days a doctor may need to prescribe an antibiotic or antifungal treatment.

There are ways to minimise your chance of developing this skin disorder:

  • Use only clean spa or heated pools. Clean your own pools regularly, especially in very hot weather, and add the correct amount of chlorine to decrease the chance of bacterial growth
  • Keep skin clean and dry
  • Avoid using skin products that can clog pores and hair follicles
  • Avoid tight clothes that cause friction between skin and clothing
  • Avoid shaving if possible or use other methods such as hair removal creams
  • Don’t share razors, face cloths or towels
  • Shave with care (as well as with waxing, electrolysis, and plucking).
  • Try and shave less frequently, or grow a beard!
  • Wash skin with an antibacterial soap beforehand
  • Use a sharp blade in the direction of hair growth, don’t shave too close and rinse often.

This blog provides general information and discussion about medicine, health and related subjects. The information contained in the blog and in any linked mate­ri­als, are not intended nor implied to be a substitute for professional medical advice.

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