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Folliculitis Barbae

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What is folliculitis barbae?

Hairs are formed within the skin in tiny structures known as hair follicles. The word folliculitis describes inflammation of hair follicles and may happen anywhere on the body. 

The term folliculitis barbae is inflammation of hair follicles in the beard area (‘Barba’ is the Latin word for beard).

What causes folliculitis barbae?

Infection usually causes folliculitis barbae with the bacterium Staphylococcus aureus (S. aureus) in the beard hair follicles. It can occur in an unshaven beard area, but more commonly affects men who shave.

Reinfection is common, especially in people who have nasal discharge, sinusitis, or hay fever as bacteria live inside the nose.

It can also be caused by contaminated shaving equipment. The infection usually occurs in the upper part of hair follicles near the skin surface. In some cases, the infection is deeper and affects more in-depth parts of the follicles.

The inflammatory reaction can involve adjoining follicles causing larger swellings. This condition is called sycosis barbae, and it occasionally leads to scarring

Less commonly, fungal or herpes virus infections may infect the hair follicles of the beard, but this is usually referred to as folliculitis barbae. 

What are the symptoms of folliculitis barbae?

Folliculitis barbae is an itchy or sore area of raised spots or pustules (pus-filled bumps) in the beard area. These spots are easily cut by a razor when shaving, causing bleeding and the spread of infection to other hair follicles in the nearby area.

How does folliculitis barbae look like?

The infected hair follicles in the beard area appear as small red swellings where the hairs come through the skin; often, the follicle is filled with pus and seals over to form a yellow-colored pimple (pustule). Many follicles are usually affected.

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

Irritation due to ingrowing hairs (Pseudofolliculitis – see related PIL) can look similar to folliculitis barbae and have similar symptoms, but usually, when a curly hair grows back into the skin (ingrowing hairs), this can be seen with a magnifying glass.

How will folliculitis barbae be diagnosed?

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

A swab 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, a doctor may take swabs from the nose to check whether the infection is being caused by bacteria carried in the nostrils.

Can folliculitis barbae be cured?

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

How can folliculitis barbae be treated?

  • Treatment options include oral antibiotics and topical antibiotic creams.

Self-care (What can I do?)

If folliculitis barbae is persistent, you should reduce contamination from shaving equipment, e.g., using disposable razors or cleaning electric shavers regularly. Metal parts of a shaver can be sterilized 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.

It may also be helpful to shave less frequently and aim to have a 5 o’clock shadow, i.e., not to shave too closely.