MRSA folliculitis

MRSA folliculitis is a superficial infection of hair folliclescaused by methicillin-resistant Staphylococcus aureus. It appears as multiple small red or white-tipped bumps, often around shaved or friction-prone areas. It is usually milder than a boil or abscess but can spread or deepen if not treated.

MRSA folliculitis produces small raised bumps, each centred on a hair. The bumps may be red, skin-coloured, or tipped with white or yellow pus. They can be itchy or tender and sometimes look like acne. The surrounding skin may be mildly red. Unlike acne, folliculitis tends to appear suddenly after shaving, friction, or sweating and can be more inflamed.

• Beard area (sycosis barbae) — often after shaving
• Thighs and buttocks — common with tight clothing or friction
• Armpits and groin — warm, moist areas with hair
• Scalp
• Any area shaved, waxed, or plucked

MRSA folliculitis begins when the bacteria enter a hair follicle through a tiny break in the skin. Triggers include shaving, waxing, plucking, tight clothing, athletic equipment rubbing the skin, sweating, hot tubs, and skin conditions such as eczema. People who carry MRSA in the nose, groin, or skin are more likely to develop it.

Contact sports such as wrestling, rugby, and American football increase risk because of skin-to-skin contact and shared equipment. Athletes with draining lesions should be evaluated and should not compete until lesions can be covered.

Mild cases may improve by stopping the trigger — for example, pausing shaving, wearing looser clothing, applying warm compresses, and keeping the area clean and dry. A clinician may take a swab to confirm MRSA and guide treatment.

Antibiotics are used for more widespread, persistent, or painful folliculitis. Oral options include clindamycin, doxycycline, trimethoprim-sulfamethoxazole, or minocycline. Topical antibiotics such as mupirocin may be used for localised folliculitis or as part of decolonisation.

Recurrent folliculitis may require decolonisation: chlorhexidine washes, mupirocin nasal ointment, and laundering of towels, bedding, and clothing in hot water. Household members with similar bumps may also need assessment.

• Pause shaving the affected area until it heals
• Use clean razors and do not share them
• Avoid tight clothing and friction over affected skin
• Shower after sports and wash hands after touching lesions
• Do not share towels, clothing, or sports equipment
• Keep skin dry and treat underlying skin conditions such as eczema

• Bumps are painful, rapidly increasing, or producing pus
• The rash spreads or does not improve after a few days
• You develop fever, chills, or red streaks
• A deep, painful lump forms — this could be a developing boil
• You have diabetes, a weakened immune system, or recurrent episodes