Folliculitis Treatment and Medications

What is folliculitis?

Folliculitis is a swelling of the hair follicles, the tiny pouches in the skin from which hair grows. There are many causes of folliculitis including infection, irritation, blockage, or injury. Any place on the body that has hair is vulnerable to folliculitis, which means everywhere except the palms and the soles.

Folliculitis is typically categorized by the underlying condition. It is usually caused by a bacterial infection, viruses, fungus, and even parasites, such as worms or mites. Types of folliculitis include:

• Bacterial folliculitis. Over 80% of folliculitis cases are caused by bacteria, usually Staphylococcus aureus, a type of bacteria that lives on everybody’s skin.
• Hot tub folliculitis (hot tub rash). A type of bacterial folliculitis, “hot tub” folliculitis is a rash or group of small red bumps caused by Pseudomonas aeruginosa bacteria. This pathogen thrives in poorly maintained hot tubs, saunas, or swimming pools.
• Barber’s itch (pseudofolliculitis barbae or razor bumps). Frequent or improper shaving often causes ingrown hairs that swell and redden.
• Malassezia folliculitis. Caused by yeast, Malassezia folliculitis (which used to be called Pityrosporum folliculitis) is most common among adolescents. It is frequently misdiagnosed as acne but does not improve with acne treatments.
• Viral folliculitis. Caused by the herpes zoster or molluscum viruses, viral folliculitis is rare and usually appears near cold sores.
• Drug-induced folliculitis. Some medications, such as corticosteroids, can cause folliculitis as a side effect.

How is folliculitis diagnosed?

Most cases of folliculitis go undiagnosed. The condition is benign, often mistaken for acne, and usually resolves in a few days to a couple of weeks.

Folliculitis treatment options

The condition can be treated at home by:

• Applying warm, moist compresses to the affected area to speed the healing process;
• Using over-the-counter anti-itch or anti-inflammatory medications to relieve symptoms;
• Routinely and gently washing the affected area with antibacterial soap or antimicrobial washes;
• Keeping the area free of oils or makeup;
• Wearing only loose-fitting clothing over the area; and
• Avoiding further injury or irritation by not scratching, shaving, or waxing the area.

If the condition persists for more than two weeks, spreads, or grows more severe, a family healthcare provider or dermatologist will turn to medications or surgery.

Medications

Depending on the condition, treatment will start with medications that directly target the underlying cause. Most cases of folliculitis are due to infections by either bacteria, herpes virus, fungus, mites, or worms, so the drugs of choice will be topical or oral drugs that kill or stop the growth of the infecting organisms. For cases involving significant discomfort, the dermatologist may prescribe topical corticosteroids to relieve the pain and itching.

Surgery

More serious infections may require outpatient surgeries, such as incision and drainage (lancing) for boils or carbuncles to drain the excess pus. For viral infections, the dermatologist may scrape away the infected tissue, called curettage, or freeze it (cryotherapy), but that will depend on the type of virus causing the infection.

UV light therapy

A rare form of folliculitis, called eosinophilic folliculitis, is caused by an overactive immune system. Follicles fill up with white blood cells and become swollen, red, and pus-filled. Exposing the affected area to ultraviolet light slows down the immune system and reduces both the swelling and pustules.

Laser hair removal

Chronic folliculitis may require the removal of the hair follicle using lasers.

Folliculitis medications

Antiseptics

Over-the-counter topical antimicrobial washes and medications are often the first-line medical treatment for folliculitis, whether it’s treated at home or under the care of a healthcare provider. A daily regimen of benzoyl peroxide washes are usually enough to effectively treat folliculitis or prevent its recurrence.

Antibiotics

If bacterial folliculitis worsens, spreads, or will not go away, a dermatologist will prescribe topical antibiotics such as mupirocin or clindamycin. If the condition does not respond to topical antibiotics, oral antibiotics such as cephalexin, ampicillin, or ciprofloxacin will be used depending on the type of bacteria causing the infection.

Antifungals

For fungal infection, oral fluconazole or itraconazole may be used. Fungal folliculitis might go on for years because the condition is mistaken for acne, but when treated with antifungal drugs, the condition rapidly clears up.

Antivirals

Herpes infections will be treated with antiviral drugs such as acyclovir or valacyclovir, but molluscum infections may have to be treated with surgery.

Antiparasite drugs

Parasite folliculitis is rare and mostly caused by a type of mite called Demodex, a small animal related to spiders. Every human being has a population of mites living on their skin and many people have Demodex living harmlessly in the hair follicles on the face. They can, however, get out of control and cause folliculitis or rosacea. The drug of choice is topical permethrin, an insecticide, or ivermectin, a broad-spectrum antiparasite drug.

Retinoids

Retinoids are drugs related to vitamin A and are often used to treat acne or severe acne. Oral isotretinoin is the most effective treatment for gram-negative folliculitis caused by certain types of bacteria. It is also the go-to treatment for the most severe and resistant cases of scalp folliculitis called folliculitis decalvans. Other types of folliculitis, like barber’s itch, may be treated by a combination of topical retinoids with topical corticosteroids.

Corticosteroids

Over-the-counter topical corticosteroids can help manage the itching, discomfort, and swelling due to folliculitis. A healthcare provider may prescribe prescription-strength corticosteroid creams in severe cases.

What is the best medication for folliculitis?

Most medications prescribed for folliculitis are intended to treat the underlying infection. Some drugs, like corticosteroids, help manage the symptoms. The best medication is the one that eliminates the infection with a minimum of side effects, but that will depend on the type and severity of the infection.

The standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institute of Health (NIH). Dosage is determined by your healthcare provider based on your medical condition, response to treatment, age, and weight. Other possible side effects exist.

What are the common side effects of folliculitis medication?

There are a number of common side effects of folliculitis medications, and different classes of medications have different side effects. However, this is not a complete list, and you should consult with your healthcare professional for possible side effects and drug interactions based on your specific situation.

Antiseptics

Antimicrobial drugs such as benzoyl peroxide are safe to use. Side effects are usually temporary site reactions such as stinging, burning, or redness.

Antibiotics

Topical antibiotics cause minimal side effects, usually stinging, rashes, or allergic reactions. Oral antibiotics can cause more side effects, particularly upset stomach, intestinal problems, loss of appetite, and allergic reactions, which can be severe for some people. They may sometimes result in a yeast infection.

Antifungals

Side effects will depend on how the drug is taken. Topical antifungals typically have minimal side effects that are only rarely experienced. These include temporary burning, stinging, or swelling where the medication is applied. Oral antifungal drugs may cause stomach problems, diarrhea, or gas.

Antivirals

Topical antiviral drugs have few and minimal side effects. Usually, they are site reactions such as burning, peeling, dryness, and itching.

Antiparasite drugs

Parasites like mites or worms are treated with poisons, so anti-parasite drugs should not be put anywhere near the mouth, nostrils, eyes, or open cuts or sores. If used as directed on the skin, side effects will be minimal.

Retinoids

Retinoids are relatively safe medications when applied topically. The most common side effects are immediate site reactions like burning and stinging. Oral retinoids can cause dryness of the skin, eyes, mouth, and lips, as well as skin peeling, skin cracking, and swelling of the eyes. Oral retinoids can cause birth defects, so women of child-bearing age will often be required to take birth control pills.

Steroids

Topical corticosteroids may cause problems when used excessively or over a long period. They can thin the skin, change skin pigment, and leave stretch marks. Worse, steroids are the major cause of drug-induced folliculitis, so they should be used cautiously and only as directed.

What are the best home remedies for carpal folliculitis?

Most people with folliculitis never see a healthcare provider. Many do nothing at all. Anyone with a mild case of folliculitis, though, can speed recovery and find symptom relief through these home remedies:

Practice good hygiene

Wash the affected area two to three times a day with oatmeal, aloe vera, or mild antibacterial soap. Try to avoid soaps that have skin irritants such as sodium lauryl sulfate.

Wear loose clothing

Folliculitis has many causes, including tight clothing, but tight clothes can aggravate the condition regardless of what caused it. Use loose-fitting clothing over the affected area. You should also avoid clothing that allows the skin to rub against the affected area.

Avoid or modify shaving

Folliculitis may be caused by shaving, but no matter what the cause, shaving can make the problem worse. If you need to shave, moisten the hairs first with water or lotion, shave only with a sharp razor or electric razor, and shave with rather than against the grain of the hairs. Avoid stretching the skin while you shave.

Use a moist compress

To relieve the itching and pain, regularly apply a towel, washcloth, or compress moistened with warm salt water to the affected area 15 to 20 minutes at a time. Boil the water first to kill any microbes. The warm water will increase blood flow and help drainage.

Use antibacterial topical medications

Over-the-counter antiseptic medications, such as benzoyl peroxide, chlorhexidine, or tea tree oil can help fight the infection.

Use anti-itch creams or NSAIDs

To relieve itching, pain, and swelling, use over-the-counter topical medications containing hydrocortisone or oral NSAIDs such as ibuprofen. Keep in mind that hydrocortisone itself can cause folliculitis, so use it with caution.

Use over-the-counter antihistamines

Oral Benadryl, loratadine (Claritin), or other antihistamines can relieve the itching and discomfort of folliculitis as it heals.

Frequently asked questions about folliculitis

What does folliculitis look like?

Folliculitis looks a lot like pimples, that is, red, swollen areas on the skin. The area may fill with pus and look like a whitehead surrounded by a red ring. Boils and carbuncles will result from a severe infection.

Can scalp folliculitis be cured?

Mild forms of scalp folliculitis can be successfully treated with the appropriate shampoos (either antifungal or antibiotic shampoos). Severe forms are resistant to treatment, and folliculitis decalvans, the most severe form of scalp folliculitis, can often only be managed rather than cured.

What kills folliculitis?

Folliculitis caused by bacteria, viruses, yeast, or parasites can be “killed” by using medications that fight the infecting organism. Folliculitis caused by medications, sunlight, or shaving cannot be “killed,” but it can be treated and prevented.

How do you know if folliculitis is healing?

Folliculitis usually takes a few days to two weeks to resolve. You can manage the condition with warm, moist compresses, good hygiene, oral antihistamines, and topical medications. If the problem persists for longer than two weeks, spreads to other parts of the body, or if the pain or itching gets worse, consult with a healthcare professional.

How do you stop folliculitis from spreading?

Folliculitis is a localized problem, but if it’s caused by an infection, that infection could spread. To prevent the infection from spreading, avoid scratching or shaving the area, clean the affected area regularly, and use topical antiseptics like benzoyl peroxide. If you have hot tub folliculitis, stay out of hot tubs and swimming pools until the problem resolves.

How do I get rid of folliculitis fast?

Like all conditions or infections, the body will require time to fight the infection. The process can be helped by applying warm, moist compresses to the area to increase blood flow, using topical antimicrobial medications, and keeping the area clean. If you have hot tub folliculitis, the fastest way to treat the condition is to stay out of hot tubs or swimming pools.

What aggravates folliculitis?

In order not to aggravate folliculitis, avoid scratching or picking at the bumps, shaving the area, covering the area in makeup, or wearing tight clothing over the affected area (or going back into a swimming pool or hot tub if you have hot tub folliculitis, as mentioned above).

What do doctors prescribe for folliculitis?

Healthcare providers will prescribe a medication to treat the underlying infection: topical antibiotics such as clindamycin or mupirocin for mild bacterial infections, oral antibiotics for severe infections, oral antifungals for yeast infections, and antiviral drugs if the condition is caused by a virus. For parasites, such as mites, they will usually prescribe permethrin. In some cases, a healthcare provider may prescribe retinoids to treat the condition or corticosteroids to relieve symptoms.

Why does folliculitis keep coming back?

Folliculitis keeps coming back for one of two reasons. First, folliculitis keeps returning because the infection that causes folliculitis keeps returning. Chronic infections of any type require medical attention, but some, like fungal folliculitis, have routine flare-ups during warmer seasons and will require preventive treatment. Second, folliculitis can keep coming back if people persist in activities that either injure the hair follicles or expose them to infection. Improper shaving, poor hygiene, makeup, and using poorly maintained hot tubs or pools can result in repeated bouts of folliculitis.

Related resources for folliculitis

• Folliculitis
• Interventions for bacterial folliculitis and boils (furuncles and carbuncles)
• Pseudofolliculitis barbae; current treatment options, clinical, cosmetic and investigational dermatology
• Special types of folliculitis which should be differentiated from acne
• Bacterial skin and soft tissue infections
• Human demodex mite: The versatile mite of dermatological importance
• Malassezia (Pityrosporum) Folliculitis
• Unconventional uses of laser hair removal: A review