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Folliculitis barbae

FOLLICULITIS BARBAE

What are the aims of this leaflet?

This leaflet has been written to help you understand more about folliculitis barbae. It tells you what it is, what causes it, what can be done about it, and where you can find out more about it.

What is folliculitis barbae?

Hairs are formed within the skin in tiny structures known as hair follicles. The word folliculitis describes an inflammation of these hair follicles. This may happen anywhere on the skin; the term folliculitis barbae is confined to inflammation of the hair follicles in the beard area (‘barba’ is the Latin word for beard). 

What causes folliculitis barbae?

Folliculitis barbae is usually caused by infection with Staphylococcus aureus (S. aureus); a bacterium that commonly infects the skin. It can occur in an unshaven beard area, but more commonly affects men who shave. Reinfection is common, either from inside the nose where these bacteria can live unnoticed, or from contaminated shaving equipment.

Most commonly the infection involves the upper part of the hair follicle, near the skin surface. In some cases, however, the infection is more deeply-seated, and the immune system sets up an inflammatory reaction involving a number of adjoining follicles. This is called sycosis barbae. Occasionally this inflammation leads to scarring.

Sometimes S. aureus is not the cause of infection and other skin bacteria which are usually harmless may be involved.

Less common infections, for example fungal infection or with the herpes virus, can also involve the follicles of the beard, but are not normally referred to as folliculitis barbae.

Is folliculitis barbae hereditary?

No.

What are the symptoms of folliculitis barbae?

Folliculitis barbae is itchy, and sometimes sore. Raised spots or pustules could be cut by a razor, causing bleeding and spread infection to other hair follicles in the nearby area.

What does folliculitis barbae look like?

A recent infection of a hair follicle in the beard area causes a small red swelling to appear around the point where the hair comes out of the skin; often the follicle becomes clogged with pus and seals over to form a yellow-coloured spot (a pustule). Many follicles are usually affected. If the inflammatory reaction develops, the areas of redness extend out from the follicles and may join up, and there will be more irritation.

In sycosis barbae there are large red swollen areas with tender lumps (like boils), some of which discharge pus making the discomfort more intense.

Irritation due to ingrowing hairs (Pseudofolliculitis – see related PIL) can look similar to folliculitis barbae; but usually the ingrowing hairs causing pseudofolliculitis can be clearly seen with a magnifying glass.

How will folliculitis barbae be diagnosed?

Close examination of the skin should show whether the spots are due to ingrowing hairs (pseudofolliculitis) rather than true folliculitis barbae. Sometimes both conditions can be present together.

A sample of the pus may be taken to test for infection and to see which antibiotics are most likely to help. If the folliculitis does not clear quickly, it may help to take swabs to check whether the infection is being caused by bacteria carried in the nostrils or in the noses of other family members, close friends and contacts.

Can folliculitis barbae be cured?

Most people will respond to treatment but in some the folliculitis can become a recurring problem. Any scarring which develops will be permanent, although its appearance will usually improve over a period of months and years. 

How can folliculitis barbae be treated?

  • The infection should respond quickly to a short course of a suitable topical antibiotic applied to the skin.

  • If reinfection comes from inside the nose, an antibiotic ointment should be applied inside the nostrils, and sometimes other family members, close friends and contacts who may carry infection in the nose, also need to be treated.

  • If chronic inflammation has developed, a mild steroid cream, in addition to an antibiotic, may help.

  • In more severe cases, your doctor may suggest an antibiotic to be taken orally, which may act through an anti-inflammatory as well as an antibacterial effect.

Self care (What can I do?)

If your folliculitis is persistent you should take steps to reduce contamination from shaving equipment, e.g. using disposable razors, or cleaning electric shavers regularly. Metal parts can be sterilised with boiling water. If the razor or electric shaver has plastic parts in contact with the skin, these should be carefully cleaned after each shave and soaked in an alcohol based antiseptic solution. An antiseptic lotion may also be recommended in place of the usual shaving soap or foam.

Where can I get more information about folliculitisbarbae?

Please be advised that several sites on the internet confuse folliculitis barbae with pseudofolliculitis.

Web links to detailed leaflets:

http://www.livestrong.com/article/165376-how-to-treat-folliculitis-barbae/

For details of source materials used please contact the Clinical Standards Unit (clinicalstandards@bad.org.uk).

This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: its contents, however, may occasionally differ from the advice given to you by your doctor.

This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel

BRITISH ASSOCIATION OF DERMATOLOGISTS

PATIENT INFORMATION LEAFLET

PRODUCED DECEMBER 2006

UPDATED JULY 2010, JANUARY 2014

REVIEW DATE JANUARY 2017

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