what is folliculitis malassezia yeast infection acne
Pityrosporum folliculitis

Folliculitis describes any condition where an infection (or other factor) causes inflammation of the hair follicles. Infectious organisms can include viruses, fungi, yeast and bacteria, with Staphylococcus aureus the most common cause of folliculitis.

What is Folliculitis?

Types of Folliculitis

Eosinophilic folliculitis is a type of folliculitis that mainly affects people with HIV/AIDS and which is thought to involve the same yeast-like fungus that causes pityrosporum folliculitis (common in teenagers and men). Symptoms of eosonophilic folliculitis also include itchy, red, inflamed pustules on the upper chest as well as on the scalp, face, and neck. These pustules are usually recurring, are typically intensely itchy and often spread to other areas of skin. As the sores heal, they often cause hyperpigmentation in the skin.

Gram-negative folliculitis

Gram-negative folliculitis is a specific subtype of acne that may arise as a result of long-term antibiotic treatment. Like other types of folliculitis, it is caused by an infection of the follicles, although in this case that infection involves gram-negative organisms.

This skin condition may also arise as a complication of acne vulgaris and rosacea, as well as after immersion in a hot-tub, and in cases of HIV infection.

Other causes of folliculitis

Some cases of folliculitis occur due to ingrown hairs, often in areas that are frequently shaved. The scalp has the highest density of hair follicles on the body, while the palms, lips, soles of the feet and mucous membranes have no hair follicles. Depending on the degree to which hair follicles are affected by folliculitis, the condition is usually graded as superficial or deep.

Hair follicles that have been damaged are more prone to folliculitis, and anyone suffering from this condition would be wise to look at protecting the follicles where possible. Common risk factors for folliculitis include:

  • Dermatitis, acne and other skin conditions
  • Shaving
  • The use of steroid creams or long-term antibiotic treatment
  • Wearing tight clothing that traps heat and sweat
  • The use of plastic dressings, tape or other skin covering
  • Wearing rubber gloves, waders, high boots
  • Scratches, scrapes, surgery and other skin injuries
  • Medical conditions such as diabetes, leukemia and HIV/AIDS that increase infection risk
  • Being overweight
  • Soaking in a poorly maintained hot tub.

Diagnosing Folliculitis

malassezia furfur yeast infection acne diagnosing folliculitis
Malassezia furfur, a type of yeast that causes folliculitis.

When diagnosing folliculitis, a physician will look at the skin, take a clinical history and assess exposure to these risk factors. A skin swab may be taken if usual treatments fail to resolve folliculitis, and this sample will be used to determine the cause of any infection. Skin biopsy is rarely necessary, but may be performed to rule out other skin conditions. During diagnosis, a physician or dermatologist will usually assess whether there is a bacterial or fungal infection causing folliculitis. Other types of micoorganism can also lead to folliculitis, but the most common culprits are Staphylococccus aureus (a bacterium), Candida albicans, and Malassezia yeasts.

Once a diagnosis of folliculitis has been made, treatments will be prescribed depending on the severity and cause of the problem. Personal preferences and existing skin care regimens will also be taken into account. It is also important to look at ways to reduce the risk of reinfection, rather than simply concentrating on symptomatic relief or short-term eradication of infection.

Untreated or poorly managed folliculitis can lead to recurrent and spreading infection, boils under the skin (furunculosis), large and itchy skin plaques, destruction of hair follicles (causing permanent hair loss), and permanent skin damage, such as hyperpigmentation.

Read on to learn about folliculitis treatment.

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