The 5 types of folliculitis (causes and treatment)

With its approximately two square meters of extension, the skin is by far the largest organ in our body. An organ that protects us from external threats at the same time that it makes it possible for us to capture stimuli and that is made up of different structures that, working in a coordinated way, allow this skin to fulfill its physiological functions.

And one of them are known as hair follicles, which, also receiving the name of "hair root", being located in the dermis (the intermediate layer of the skin, below the epidermis, being the thickest), host the metabolic and mitotic reactions for hair development.

Now, these follicular ducts can both be damaged (when shaving or by suffering friction against clothing) and blocked, something that can result in a bacterial or fungal infection and a consequent inflammation that gives rise to a common dermatological pathology known as folliculitis.

And in today's article, In addition to understanding exactly the clinical bases of this folliculitis, we will see what classes exist, as there are different types depending on their causes, symptoms and treatment. And it is that this disease, although it is not a health risk, it can cause pain, itching and embarrassment. It is for this reason that it is so important to know its characteristics.

What is folliculitis?

Folliculitis is a dermatological disease that consists of the infection and subsequent inflammation of one or more hair follicles of the skin, the ducts that extend from the intermediate layer that is the dermis to the outside and inside which the hair grows. In this sense, folliculitis is a pathology in which the small bags from which the hair grows become inflamed as a consequence of, generally, a bacterial or fungal infection.

In fact, the most common is that the problem begins with damage (from friction with clothing or from shaving or waxing) or a blockage of the hair follicles, something that increases the risk that, mainly, Staphylococcus aureus (although it can be other bacteria and even fungi or other causes that we will see later) colonize the hair root and thus an inflammatory process begins.

Folliculitis can develop almost anywhere on the body (except lips, mucous membranes and palms of both hands and feet) and, although all people can develop them, there are some risk factors: being a man with curly hair who shaves frequently, waxing, wearing tight clothing, wearing clothing that absorbs heat and sweat, receiving whirlpools in poorly maintained facilities, suffering from acne or dermatitis, taking certain medications (consult your family doctor) and, of course, suffering from a disease that weakens the immune system.

Be that as it may, folliculitis has fairly clear symptoms consisting of the appearance of whiteheaded pimples that form around the infected hair follicle, the appearance of small groups of bumps, the formation of pus-filled blisters that can form scabs, pain and skin sensitivity, itching, burning and, in some cases, the appearance of large swollen lumps.

As we see, Beyond the pain, itching and embarrassment due to the aesthetic impact, folliculitis is not a disease that represents a health hazard. But it is true that, in more serious cases that do not receive the necessary treatment, this can lead to complications such as the formation of incurable squamous ulcers (in case the infection spreads), reappearance of the infection, furunculosis (formation of clumps of pus under the skin known as boils), permanent scars, the appearance of dark spots and even permanent hair loss in that area if the follicles are destroyed by the pathology.

Therefore, in addition to preventing its appearance (shaving less frequently, avoiding tight clothing, trying other hair removal methods, applying moisturizing lotions after shaving, washing the skin with soap and water before shaving, bathing only in clean pools ...) , it is important to know its treatment, which you should consult a doctor knowing that it can consist of both drug therapy (antibiotic gels or creams to reduce inflammation) and, in more serious cases that have led to complications, surgical therapy (minor surgery for drain the pus), as well as in laser hair removal.

What kinds of folliculitis are there?

Now that we have understood the clinical bases, causes, symptoms, complications and treatment of folliculitis as a general pathology, we are more than ready to analyze the particularities of each of the types of folliculitis. So let's see how this skin disorder is classified.

1. Bacterial folliculitis

Bacterial folliculitis is that variety of the pathology in which the inflammation of the hair root is triggered caused by a bacteriological infection, usually by Staphylococcus aureus, a bacterium that is present on the skin of approximately one in three people in the world. It generally does not cause problems, but can sometimes behave as an opportunistic pathogen.

Although it can cause gastrointestinal infections, pneumonia, bone infections, bacteremia, and many other conditions, skin infections are the most common. And within them, folliculitis is one of the main ones. Bacteria take advantage of wounds in the hair follicles or blockages in the ducts to colonize them and thus cause an infection. In this case, it is characterized by white, pus-filled bumps that cause itching. Treatment consists of the application of antibiotic lotions and gels. Oral antibiotics are practically never prescribed.

2. Fungal folliculitis

Fungal folliculitis is that variety of the pathology in which the inflammation of the hair root is triggered caused by a fungal infection, usually by Malassezia furfur, a kind of fungus that is part of the skin's natural microbiota but which, as in the previous case, can take advantage of skin lesions to cause infections.

This form of the pathology is more common in adolescents and young male adults who live in humid climates, something that favors the activity of this species of yeast. In this case, folliculitis is expressed with papules and pustules, usually on the forehead, chin, neck, back, shoulders, face or trunk that usually itch evenly and that can be chronic. Treatment consists of oral administration of fluconazole, an antifungal medication.

3. Ingrown hair folliculitis

Ingrown hair folliculitis is that variety of the pathology in which the inflammation of the hair root is not due (at least initially) to a bacterial or fungal infection, but to an ingrown hair, that is, a hair that, after being shaved or plucked, grows back but in an abnormal way, under the skin and without actually coming out.

It is especially common in men with curly hair who shave frequently and without applying before or after shaving skin care treatments, such as washes with soap and water or applying moisturizing lotions. But it can happen to anyone who shaves any part of the body or who plucks or waxes.

In this case, folliculitis consists of papules (small, round, solid bumps), pustules (blister-like lesions that are filled with pus), darkening of the skin, pain, and itching. All this because a hair is embedded. To fix the problem and prevent the wound from becoming infected and leaving dark spots permanently, the hair that is embedded should be removed by putting it in the hands of a dermatologist.

4. Hot tub folliculitis

Jacuzzi folliculitis is the name given to that variety of pathology that develops due to an infection from bacteria found in settings like hot tubs, heated pools, hot tubs, or spas that don't receive proper maintenance treatments. In other words, it is the folliculitis that we suffer from bathing in places where chlorine and pH are not well regulated, something that increases the risk of infection by, generally, bacteria of the genus Pseudomonas.

Are Bacteria generally cause respiratory illnesses, but they can also lead to dermatological infections. In this case, folliculitis, which is worse in areas where the bathing suit keeps water in contact with the skin, is characterized by the appearance, between one and two days after exposure, of a red rash that is accompanied by itchy, round bumps as well as pus-filled blisters on the follicles. In this case, however, the infection resolves within a few days without the need (in the vast majority of cases) for medical treatment.

5. Deep folliculitis

So far we have seen everything related to superficial folliculitis, which, after all, is the mildest form of the disease. But there is also deep folliculitis, which is that variety in which inflammation also involves the hair bulb, which is the lowest part of the follicle and where the fungal activity of hair growth takes place. The inflammation occurs not only in the superficial part of the skin, but throughout the entire hair duct.

We find several types within this variety that obviously require a more intensive treatment, such as furunculosis (formation of accumulations of pus under the skin known as boils), carbuncle (formation of bumps under the skin) , psychosis of the beard (that deep folliculitis in the face of men who shave), eosinophilic folliculitis (of unknown cause, mainly affects AIDS patients) and gram negative folliculitis (due to a deep infection, generally in patients who have received a long-term acne therapy). Treatment will depend on the exact cause.