What is folliculitis, and what is the cause?

What is folliculitis, and what is the cause? Their internet has broken over this topic. Some call it a histamine reaction, some ingrowns, and some razor burn. One thing that we all agree on is it IS a form of folliculitis.

Let's break down the term folliculitis:

Follicul - follicle

Itis - inflammation

Make more sense now? I bet!

Folliculitis is usually caused by a bacterial or fungal infection. At first, it may look like small, red bumps or white-headed pimples around hair follicles.

The condition isn't life-threatening in nonimmune compromised clients. It is in fact itchy, sore, and unsightly. Severe cases need medical intervention. 

The two main types of folliculitis are superficial and deep. The superficial type involves part of the follicle, and the deep type involves the entire follicle and is usually more severe.

Most common folliculitis:

  • Bacterial folliculitis. This common type is associated with itchy, white, pus-filled bumps. It occurs when hair follicles become infected with bacteria. Staph can be a big culprit in bacterial folliculitis. Staph lives on all of us. This is the most common infection after waxing. Proper care after waxing is important to ensure a clean wax.

If your client is experiencing this, making these recommendations can help alleviate the symptoms:

  • Changing sheets
  • Wearing clean shirts that have been washed with fragrance free detergent
  • Limiting activities that cause sweating
  • Taking a cool shower with an antibacterial soap 2x a day for 3 days
  • Applying a topical antibiotic and antihistamine with the approval of their doctor.

If symptoms don't clear up in a few days, advise medical intervention. Be very careful about suggesting over-the-counter remedies. Word it just the right way to protect yourself from liability.

Why an antihistamine if it is a bacterial infection? The folliculitis could have been caused by a histamine reaction and morphed to a bacterial reaction. Suggesting both ointments will alleviate symptoms of both issues.

"I would recommend you do the ‘the first four steps listed above’ as well as talking to your doctor about applying Neosporin or antibiotic ointment, and an anti-histamine ointment."

Uncommon folliculitis you will see:

  • Hot tub folliculitis (pseudomonas folliculitis). With this type you may develop a rash of red, round, itchy bumps one to two days after exposure to the bacteria that causes it. Hot tub folliculitis is caused by pseudomonas bacteria, which is found in many places, including hot tubs and heated pools, in which the chlorine and pH levels aren't well-regulated.
  • Razor bumps (pseudo folliculitis barbae). This is a skin irritation caused by ingrown hairs. It mainly affects men with curly hair who shave too close and is most noticeable on the face and neck. People who get bikini waxes may develop barber's itch in the groin area. This condition may leave dark raised scars (keloids).
  • Pityrosporum (pit-ih-ROS-puh-rum) folliculitis. This type produces chronic, red, itchy pustules on the back and chest and sometimes on the neck, shoulders, upper arms, and face. This type is caused by a yeast infection. This needs medical attention as we cannot diagnose or treat.

Forms of deep folliculitis include:

These require you to STOP service and refer to a doctor. DO NOT service again without a doctor’s note.

  • Sycosis barbae. This type affects males who have begun to shave.
  • Gram-negative folliculitis. This type sometimes develops if you're receiving long-term antibiotic therapy for acne.
  • Boils (furuncles) and carbuncles. These occur when hair follicles become deeply infected with staph bacteria. A boil usually appears suddenly as a painful pink or red bump. A carbuncle is a cluster of boils.
  • Eosinophilic (e-o-sin-o-FILL-ik) folliculitis. This type mainly affects people with HIV/AIDS. Signs and symptoms include intense itching and recurring patches of bumps and pimples that form near hair follicles of the face and upper body. Once healed, the affected skin may be darker than your skin was previously (hyperpigmented). The cause of eosinophilic folliculitis isn't known.

Histamine Reactions

Histamine or utricaria is the body's immune response to trauma or the introduction of an allergen.

So how does histamine effect your client during a wax?

When we pull the hair from the follicle, we are damaging the surrounding tissue. It is this damage that triggers the histamine response. The histamine response helps nourish and heal the injured tissue.

What does this do to your clients?

When a histamine reaction happens, your client may experience a raised rash, bumps, or itchy, sore, and painful areas.

  Histamine reaction doesn't always present itself as hives. It can look like the picture on the left, and most of them will when it comes to waxing.

How can you help your client?

You must be very careful when you talk about treating or recommending anything for folliculitis or histamine reactions. You do not want to get caught in a "well she told me to" and it went poorly lawsuit. STAY IN SCOPE OF PRACTICE.

With that said, there are a few things you can recommend. If your client is experiencing this, making these recommendations can help alleviate the symptoms:

  • Change sheets
  • Wear clean shirts that have been washed with fragrance free detergent
  • Limit activities that cause sweating
  • Take a cool shower with an antibacterial soap 2x a day for 3 days
  • Apply a topical antibiotic and antihistamine with the approval of their doctor.
  • After 48 hours exfoliate at least 1x a day for a few days.
  • Do NOT pick or itch the area. A calamine lotion can help with itching.