What are the aims of this leaflet?

This leaflet has been written to help you understand more about folliculitis barbae. It tells you what it is, what causes it, what can be done about it, and where you can find out more about it.

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?

Folliculitis barbae is usually caused by an infection 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 deeper parts of the  follicles. The inflammatory reaction can involve adjoining follicles causing larger swellings. This is called sycosis barbae and it occasionally leads to scarring.

Sometimes S. aureus is not the cause of folliculitis barbae and overgrowth of other harmless skin bacteria, may be involved.

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

Is folliculitis barbae hereditary?

No.

What are the symptoms of folliculitis barbae?

Folliculitis barbae is an itchy or sore area of raised spots or pustules (pus filled spots) 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.

What 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-coloured 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 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. It may be necessary for the doctor to take swabs from the noses of other family members, close friends and contacts.

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?

• Mild infection usually responds to a short course of a suitable topical antibiotic applied to the skin.
• If reinfection is caused from inside the nose, an antibiotic ointment should be applied to the inside of both nostrils. Sometimes other family members, close friends and contacts who may carry the infection in the nose, may also need to be treated.
• If chronic inflammation has developed, a mild steroid cream, in addition to an antibiotic, may help.
• In more severe cases, your doctor may prescribe an antibiotic to be taken orally, which may act through an anti-inflammatory as well as an antibacterial effect.

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 sterilised 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 shave too closely.

Where can I get more information about folliculitis barbae?

Please be advised that several sites on the internet confuse folliculitis barbae with pseudofolliculitis.

Web links to detailed leaflets

http://www.dermnetnz.org/topics/folliculitis-barbae

Jargon Buster: https://www.skinhealthinfo.org.uk/support-resources/jargon-buster/

Please note that the BAD provides web links to additional resources to help people access a range of information about their treatment or skin condition. The views expressed in these external resources may not be shared by the BAD or its members. The BAD has no control of and does not endorse the content of external links.

This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.

This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel

BRITISH ASSOCIATION OF DERMATOLOGISTS PATIENT INFORMATION LEAFLET

PRODUCED DECEMBER 2006

UPDATED JULY 2010, JANUARY 2014, APRIL 2017

NEXT REVIEW DATE APRIL 2020