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Patient Information Leaflet

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. Sometimes S. aureus is not present, and skin bacteria which are usually harmless may then be involved.

Usually 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 a persistent inflammatory reaction leading to redness and irritation between the follicles; this may be called sycosis barbae. Occasionally the inflammation leads to scarring.

Less common infections, for example with fungi 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 tender. Spots affecting the beard area can be cut by a razor, causing bleeding.

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 with a septic yellow-headed 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 persistent large red swollen areas with tender spots some of which discharge pus making the discomfort more intense. Irritation due to ingrowing hairs (pseudofolliculitis) can look similar to folliculitis barbae; the ingrowing hairs can be clearly seen with a magnifying glass.

How will folliculitis barbae be diagnosed?

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 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.

Can folliculitis barbae be cured?

Sometimes. However, in some people, it responds less completely, though all can be helped by treatment. 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?

• A straightforward infection should respond quickly to a short course of a suitable antibiotic, either applied to the skin or taken as tablets.
  
• If reinfection comes from inside the nose, an antibiotic ointment should be applied inside the nostrils. 
  
• If chronic inflammation has developed, a mild steroid cream, including an antiseptic or antibiotic, may help. 
  
• In difficult cases, especially if S. aureus has not been found, your doctor may suggest an antibiotic which may act through an anti-inflammatory as well as an antibacterial effect. 

What can I do?

If your folliculitis is persistent you should take steps to reduce contamination from shaving equipment. Metal parts can be scalded 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 alcoholic 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 folliculitis barbae?

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

Web links to detailed leaflets:

www.emedicine.com/derm/topic159.htm 

The British Skin Foundation fund vital research into all skin diseases. To find out how you can help, please visit the British Skin Foundation website here.

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