Folliculitis, Acute Bacterial [Bockhart&#39

This page was printed on
4th December 2018

DermNet NZ


C113.610047,106.639332 110.297408,105.547544 108.863214,101.990522 C108.862416,101.98973 108.862416,101.988148 108.861618,101.987357 C110.31806,98.794243 112.545371,97.6116608 113.219769,97.3165722 C113.870181,97.032562 114.71372,96.9265367 115.384134,96.8901418 L115.384134,97.7643494 C115.384134,97.9447281 115.482295,98.1132506 115.63951,98.2026481 C115.796726,98.2928375 115.993053,98.2928375 116.150263,98.2026481 L118.691973,96.6361873 C118.849189,96.545998 118.947349,96.3782835 118.947349,96.1978886 C118.947349,96.0175099 118.849189,95.8489873 118.691973,95.7595899 L116.150263,94.1931291 C115.992249,94.1029397 115.79672,94.1029397 115.638714,94.1931291 C115.480707,94.2833185 115.383337,94.4510329 115.383337,94.6314278 L115.383337,95.5388709 C114.582089,95.5784273 113.525464,95.7089651 112.670832,96.0823848 C111.761059,96.4795291 109.694165,97.6417165 108.121047,100.442284 C106.550482,97.6416759 104.482649,96.4795494 103.572896,96.0823848 C102.007909,95.3980506 100.895531,95.5262127 100.774176,95.5428203 C100.404677,95.5942451 100.148504,95.9296962 100.197189,96.2967848 C100.245073,96.6638734 100.586628,96.9257468 100.956127,96.8798532 C100.964107,96.8790621 101.811637,96.7864982 103.024675,97.3165519 C103.699829,97.6116405 105.92718,98.7944051 107.383643,101.987337 C107.382845,101.988128 107.382845,101.98971 107.382047,101.990501 C105.397302,106.913843 101.033595,107.111514 100.850745,107.117792 C100.474872,107.127286 100.178779,107.436618 100.18836,107.809256 C100.197937,108.175554 100.50039,108.466694 100.868295,108.466694 C100.873881,108.466694 100.880266,108.466694 100.88665,108.465902 C101.092545,108.461156 105.631134,108.285524 108.131371,103.593194 C110.072231,107.052029 113.574973,108.056788 115.38651,108.348029 L115.38651,109.358318 C115.38651,109.538696 115.484671,109.707219 115.641887,109.796616 C115.799102,109.886806 115.99543,109.886806 116.152639,109.796616 L118.694349,108.230156 C118.851565,108.139966 118.949725,107.972252 118.949725,107.791857 C118.948927,107.611478 118.850766,107.443745 118.693552,107.353558 L118.693548,107.353722 Z” transform=”translate(-100 -94)”>



Topics A–Z

Bacterial folliculitis

Bacterial folliculitis

Author: Hon. Assoc. Prof. Amanda Oakley, Dermatologist, Hamilton, New Zealand. September 2015. Reviewed and updated by Dr Jannet Gomez, Postgraduate student in Clinical Dermatology, Queen Mary University London, UK. January 2016.

Bacterial folliculitis



Bacterial skin infections


Superficial folliculitis,



Gram negative folliculitis,

Hot tub folliculitis (Spa pool folliculitis)


What is folliculitis?

Folliculitis is inflammation of the hair follicle due to infection, chemical irritation or physical injury. Bacterial folliculitis is the most common form of folliculitis.

What causes bacterial folliculitis?

Bacterial folliculitis is usually due to Staphylocoocus aureus . Less often, coagulase-negative staphylococci and gram-negative organisms are responsible including anaerobes. Spa pool folliculitis is caused by Pseudomonas .

Who gets bacterial folliculitis?

Bacterial folliculitis affects children and adults, with adolescents and young adult males most often infected. It is prevalent worldwide.

The following factors predispose to bacterial folliculitis:

  • Maceration and occlusion (clothing, dressings, ointments)
  • Frequent shaving, waxing or other forms of depilation
  • Friction from tight clothing
  • Atopic dermatitis
  • Acne or other follicular skin disorder
  • Use of topical corticosteroids
  • Previous long-term use of antibiotics
  • Anaemia, obesity, diabetes , HIV/AIDS, hepatitis, cancer and other chronic illness
  • Bathing in an inadequately cleansed hot tub or pool.

What are the clinical features of bacterial folliculitis?

Bacterial folliculitis may be superficial or involve the whole hair follicle (a boil ). It may arise on any body site, but is most often diagnosed in scalp, beard area, axilla, buttocks and extremities. Systemic symptoms are uncommon. Different types of bacterial folliculitis are described below.

Superficial folliculitis

Superficial staphylococcal folliculitis presents with one or more follicular pustules. They may be itchy or mildly sore. Superficial folliculitis heals without scarring.

A hordeolum or stye is bacterial folliculitis affecting an eyelash.


Furunculosis or boils presents as one or more painful, hot, firm or fluctuant, red nodules or walled-off abscesses (collections of pus). A carbuncle is the name used when a focus of infection involves several follicles and has multiple draining sinuses. Recovery leaves a scar.

Gram-negative folliculitis

Gram-negative folliculitis develops in individuals using long term antibiotics for acne. The infection with gram negative organisms causes pustules in acne sites of the face, neck and upper trunk.

Hot tub folliculitis

Hot tub or spa pool folliculitis presents with painful papules and pustules on the trunk some hours after soaking in hot water, mainly in sites that were covered by bathing costume. It may be accompanied by mild systemic symptoms including fever. Untreated, it settles within about 10 days without scarring.

Bacterial folliculitis

Superficial bacterial folliculitis

Superficial bacterial folliculitis



Complications of bacterial folliculitis

Soft tissue infection

Bacterial folliculitis can lead to cellulitis and lymphangiitis; subsequent bacteraemia might result in osteomyelitis, septic arthritis or pneumonia.

How is bacterial folliculitis diagnosed?

Bacterial folliculitis is usually diagnosed clinically but can be confirmed by bacterial swabs sent for microscopy, culture and sensitivity.

Blood count may reveal neutrophil leucocytosis when folliculitis is widespread.

Skin biopsy is rarely necessary. Histology shows dense neutrophilic infiltrate in subcutaneous tissue and foreign body reaction around a hair shaft.

How can folliculitis be prevented?

  • Keep skin clean and if dry, well moisturised.
  • Minimise shaving and waxing . When shaving, use new blade each time and moisturise the skin afterwards.
  • Do not wear tight fitting clothes.
  • Ensure adequate sterilisation of hot tubs.
  • In case of repeated episodes of staphylococcal folliculitis, apply mupirocin ointment to the nostrils to eliminate S. aureus carrier state.

What is the treatment for bacterial folliculitis?

  • Warm compresses to relieve itch and pain
  • Analgesics and anti-inflammatories to relieve pain
  • Antiseptic cleansers (eg, hydrogen peroxide, chlorhexidine, triclosan)
  • Incision and drainage of fluctuant lesions and abscesses
  • Topical antibiotics such as erythromycin , clindamycin , mupirocin and fusidic acid. To reduce bacterial resistance , these should be applied for courses of no more than one week
  • Oral or intravenous antibiotics for more extensive or severe infections
  • Photodynamic therapy
  • Repeated laser hair removal

Ask an online dermatologist now
Securely upload your symptoms and pictures using First Derm
(Sponsored content)


Related information



  • Durdu M, Ilkit M. First step in the differential diagnosis of folliculitis: cytology. Crit Rev Microbiol. 2013 Feb;39(1):9-25. doi: 10.3109/1040841X.2012.682051. Epub 2012 May 29. Review. PubMed PMID: 22639852.
  • Folliculitis – Mayo Clinic Patient Care and Health Info

On DermNet NZ

  • Folliculitis
  • Acne
  • Furunculosis (boils)
  • Scalp folliculitis
  • Oil folliculitis
  • Gram negative folliculitis
  • Spa pool folliculitis
  • Pseudofolliculitis barbae (razor bumps)
  • Pityrosporum folliculitis
  • Folliculitis decalvans

Other websites

  • Folliculitis – Medscape Reference

Books about skin diseases

See the DermNet NZ bookstore .

Dermatology Glossary

sidebar glossary2

Check out DermNet’s new Glossary of Dermatological Terms .

sidebar donate

With your help , we can update and expand the website.

Popular topics

Acne  –  Actinic (Solar) Keratosis  –  Contact Dermatitis  –  Alopecia  –  Basal Cell Carcinoma  –  Bee and Wasp Stings  –  Dermatitis  –  Dermatofibroma  –  Drug Eruptions  –  Erythema Multiforme  –  Melanoma  –  Pityriasis Rosea  –  Pityriasis Versicolor  –  Psoriasis  –  Rosacea  –  Spot the Difference!  –  Scabies  –  Vitiligo

Sign up to the newsletter

Add the DermNet Search Bar

sidebar search tool2

You can now embed our Search Bar in your independent practice, hospital website or blog.

© 2018 DermNet New Zealand Trust.

DermNet NZ does not provide an online consultation service. If you have any concerns with your skin or its treatment, see a dermatologist for advice.