Folliculitis Barbae

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; but 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, a bacterium (germ) 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 staphylococcus aureus is not found, and skin bacteria which are usually harmless may then be involved.

Usually the infection is of the outer part of the hair follicle, near the skin surface. In some cases, however, the infection is deeper 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’ (please note that this has nothing to do with psychosis, a severe type of mental illness). Occasionally the inflammation leads to scarring.

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

Irritation due to ingrowing cut hairs is a different problem, sometimes included as a form of folliculitis barbae.  Please see the separate information page on “Pseudofolliculitis”, on this website.

Is folliculitis barbae hereditary?

No.

What are the features of folliculitis barbae?

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). This will be slightly tender, and will bleed if cut by a razor. Usually many follicles are 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 the deeper form (known as sycosis), there are persistent large red swollen areas with tender lumps, some of which discharge pus, and the irritation is more intense.  

How will folliculitis barbae be diagnosed?

Samples 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 bacteria are being carried in the nose too, or on the skin 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 are present together.

Can folliculitis barbae be cured?

Often it can be cured quickly.  However some people with persistent folliculitis respond less quickly, though all can be helped by treatment. Any scarring which develops will be permanent, although its appearance will usually improve gradually.  

How can folliculitis barbae be treated?

A straightforward recent infection should respond quickly to a short course of a suitable antibiotic, either applied to the skin or taken as tablets.  

If re-infection comes from inside the nose, an antibiotic ointment should be applied inside the nostrils. 

If chronic inflammation has developed, a mild hydrocortisone cream, including an antiseptic or antibiotic, may help.

In difficult cases, especially if staphylococcus 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.

While every effort has been made to ensure that the information given in this leaflet is accurate, not every treatment will be suitable or effective for every person. Please consult your doctor if you have any concerns about your skin health. He or she will be able to advise in greater detail.