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Follicular Eczema: Treatment, Symptoms, and Causes

Posted on January 10, 2022
Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
Jessica Wolpert

Follicular eczema describes eczema (atopic dermatitis) that has affected the hair follicles. Your hair follicles are the tiny tubes in your skin through which hair grows. As with other types of eczema, you may experience itching, redness, and oozing bumps on your skin, specifically surrounding the follicles. Follicular eczema occurs most commonly surrounding body hair on the chest, arms, back, stomach, or legs.

Causes of Follicular Eczema

The cause of follicular eczema is not yet fully understood. Eczema is a skin condition that likely occurs when a genetic predisposition causes the immune system to react to certain environmental triggers, allergens, or irritants. Common triggers can include:

  • Car exhaust
  • Dust
  • Mold
  • Infection
  • Soaps and detergents
  • Harsh fabrics such as wool
  • Perfumes, lotions, sprays, and cosmetics

Follicular eczema, in particular, may be due to decreased barrier function of the skin. This is common in people with eczema due to a lack of certain skin barrier proteins. Poor barrier function allows bacteria and other microbes to enter the skin and cause inflammation. Scratching the itchy skin can also lead to cracks and bleeding, further increasing the risk of bacterial or fungal infection. These skin infections can cause folliculitis (inflammation of the hair follicles), leading to the symptoms of follicular eczema.

Symptoms of Follicular Eczema

Follicular eczema may cause symptoms such as:

  • Dry skin
  • Patches of thickened or hardened skin
  • Itchy rash that surrounds the hair on the chest, arms, stomach, back, or legs
  • Tiny red, purple, or gray bumps that may resemble goosebumps

Eczema is usually described as involving large patches of discolored, itchy skin or bumps. People with darker skin experiencing eczema can have small bumps that appear darker brown, purple, or ashy. For people with lighter skin, the bumbs are usually red. Pigment changes may temporarily make the skin lighter or darker than it was before the eczema flare-up. The skin usually returns to its original color within several months, although the color may never completely return to normal.

Follicular eczema affects the hair follicles, the places on your skin where hair grows. (DermNet NZ)
Follicular eczema can cause an itchy rash. (DermNet NZ)

Follicular eczema occurs most commonly on the torso, arms, or legs where body hair grows. (DermNet NZ)

Treating Follicular Eczema

Treatments for follicular eczema resemble treatments for eczema in general. Here are tips to help soothe skin irritation and other symptoms of your eczema.

Bathing

Appropriate skin care is the first step in treating follicular eczema. When you bathe or take a shower, use warm water (not hot) to avoid worsening dry skin. You may also want to try oatmeal baths and bleach baths, which can help decrease inflammation, restore barrier function to the skin, and eliminate harmful bacteria on the skin. Talk to your doctor for their medical advice before trying a bleach bath, and be sure to follow their directions for diluting the bleach correctly. Shorter baths are better for the skin, and gentle skin cleansers without dyes and fragrances are less likely to irritate your skin and trigger eczema.

Moisturizing

Keep your skin moisturized when you have eczema. You can treat affected skin with thicker emollients, such as shea butter, petroleum jelly, and certain lotions. Make sure to use a fragrance-free moisturizer so you don’t introduce other allergens or irritants to your skin. The best time to moisturize is right after bathing, when the skin is warm and moist.

Steroid Creams

Topical corticosteroids, such as hydrocortisone, can also be used to treat eczema. However, steroids can typically be used only for limited periods of time. Talk to your doctor about this option. Some steroids are available over the counter, and others are available in prescription strength. Newer nonsteroidal creams can be used to minimize the use of steroids on the skin.

Phototherapy

For people with severe eczema, phototherapy may be helpful. Phototherapy is a treatment in which a clinician exposes your skin to controlled doses of ultraviolet light. This treatment is usually effective for all skin shades and tones.

Read more about eczema treatments.

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Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Jessica Wolpert works to empower patients through the creation of content that illuminates treatments' effects on the everyday lives of people with chronic conditions. Learn more about her here.

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