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Straight, No Chaser: Hot Tub and Barbershop Folliculitis (Yep, Even More Staph Infections!)

By Jeffrey Sterling, MD November 15, 2018

hottubfolliculitis_20 Folliculitis
Follulicitis. You know it well as hot tub rash, barber bumps, ingrown hairs and many other names. The first thing you need to know is the ‘itis’ means inflammation, and the follicle is the pouch from which your hair grows. Any inflammation of that area is folliculitis. You’ll typically see white-headed pimples with or without itching, pain and redness. So what? Let’s quickly run through causes, problems, prevention and treatment.
Causes

  • It’s usually caused by microorganisms (usually bacteria, including Staph and others, but also yeast, fungi and viruses may do the same).
  • Blocking skin pores will also get you there (think heavy application of make-up or oils, or heavy sweating in tight spandex-type clothing).
  • External irritation can be a cause (think long-term topical steroid use, tight clothing, untreated scratches or lacerations, improperly chlorinated hot tubs, whirlpools or swimming pools).

Problems
It’s inflammation that most commonly is an infection. The irritation can progress to a skin infection (cellulitis) and/or a boil (abscess). These can range from annoyances to ‘not-fun’ to outright problematic, particularly if you’re diabetic, have HIV or otherwise have a compromised immune system.
Prevention
I’m just going to give you a list of healthy hygiene tips that will serve you well in many circumstances, including prevention of folliculitis.

  • Use antimicrobial soap.
  • Don’t share towels, and avoid using the same towel multiple times (Sorry, hotel chains!).
  • Shower immediately after getting out of the swimming pool, whirlpool or hot tub.
  • Don’t shave (and avoid otherwise irritating) areas where razor bumps exist.
  • Be moderate with application of lotions, makeups and other moisturizers.

Treatment
Most cases of folliculitis, whether an inflammation or an infection, resolve in 1-2 weeks, assuming you don’t further irritate it to the point where an substantial skin infection sets in. Consider the following a treatment progression for the overwhelming majority of cases; cases more severe (or any you may be concerned with) require consultation with your individual physician.

  • Warm compresses (clean, hot towels) to the area do a world of good.
  • Wash with antimicrobial soap, and consider using medicated shampoo, particularly if the discomfort is on the scalp and/or beard.
  • Your physician may consider topical or oral antibiotics if the situation warrants or worsens. That means you need to be alert for spreading of the bumps, fever, drainage or worsening of pain, swelling or redness.

Good luck, and I welcome your questions or comments.
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0 thoughts on “Straight, No Chaser: Hot Tub and Barbershop Folliculitis (Yep, Even More Staph Infections!)

  1. I’ve been wondering about folliculitis. An MD told us it is what our 15yr old has several years ago as puberty set in. It still has nkt gone away and it only disappears when he goes swimming or takes a tub bath with a 1/4 c. Bleach. Does this sound characteristic of folliculitis?

    1. Hi, LaShaundra. Interesting presentation. Based on what you’re describing (particularly with the recurrences – you never did say where the rash was), it might be prudent to have some scrapings done and sent for culture. The correlation with puberty suggests hormonal causes of rash (acne vulgaris comes to mind). The disappearance after chlorine exposure brings a few additional considerations into play that a culture would identify. Folliculitis is very easily treated, as I’ve discussed. Unless the child is especially hairy and prone to ingrown hairs, I’d start looking elsewhere. Thanks for your question and following Straight, No Chaser.

      1. Thanks Doc. And it would help, huh!! Lol he is very hairy, back, chest, stomach, upper arms and upper buttocks. They did scrape the rash and folliculitis is all the answer we got. Since it has been so many uears now and this kid hates creams, I think its time to seek another MDs opinion. The worst part about it for me, is that he is a growing young man and the rash leaves behind dark scars. Seems like a revolving door. As always, thank you.

  2. I have those large bumps or blisters on my head that is in the picture. I have gone to the dermatologist spent lots of money, they ran test as well as tried removing one from my head and it grew back along with the rest of them. My hair is soft a somewhat curly. I am a black young adult who is very upset with these things in my head that itches as well, Whatever you can advised me to do I will be thankful.

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