Treating Infected Hair Follicles (Folliculitis)

I was told that I have folliculitis, and I wanted to know exactly what that is. Sometimes I get bumps or blisters in my genital area and they hurt like pimples on your face. Whenever I pull the hair out of them or squeeze them, a puslike substance comes out. They get hard and stay for weeks but eventually go away. My doctor says it isn't herpes. I just don't understand why it happens.

J.

Question:

Folliculitis is a skin infection localized to the hair follicles. It causes multiple, small (less than 5mm) red bumps at the site of a hair follicle. At the top of the bump, there is usually a tiny blister filled with pus. These lesions occur in crops in the armpit, at the beard, on the neck or in the groin. They can sometimes be quite itchy. By far, the most common bacterium involved in folliculitis is Staphylococcus aureus, often called "staph." Occasionally another organism, Pseudomonas aeruginosa, is responsible for outbreaks associated with swimming pools.

Folliculitis often recurs, and it can cause some complications. A hair follicle infection can spread to involve more skin and deeper structures. This is called a furuncle (boil). When the infection spreads even deeper and when there are several interconnecting furuncles, it is called a carbuncle. A carbuncle is often associated with fever and other signs of illness. It should be treated promptly to avoid seeding the blood with staph.

The treatment of simple folliculitis involves applying moist heat, salt-water compresses and topical antibiotics. Patients should clean the skin with soap and water and wash their hands frequently to avoid spreading the bacteria. This approach is generally sufficient, and oral antibiotics are seldom needed. There is some doubt that antibiotic pills are even helpful in this infection. Folliculitis does not generally leave scars, but the bump may be present in some form for an extended period of time. Usually the skin is completely normal after a month or so.

If a furuncle forms, it will usually need to be drained by a physician. If the patient has fever or any other symptoms of whole-body illness, most doctors will prescribe oral antibiotics.

Recurrent folliculitis and furuncules can pose a frustrating problem. It has been shown that people with frequent infections usually carry the organism in their noses. One approach to preventing the disease is to attempt to eradicate the organism from the nose with mupirocin (trade name Bactroban). In very difficult cases, this antibiotic can be applied for five days every month. In at least one study, this approach has led to marked reduction in recurrent skin infections due to staph.

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