Skin Care Myth: Are Your Acne Breakouts Folliculitis?

Imani.PrakashImani.Prakash
May 7
Folliculitis can masquerade as acne. Discover the different symptoms of folliculitis vs acne and how to treat this skin disorder.
If you’re suffering from acne-like breakouts but standard treatments aren’t working, another culprit could be responsible: folliculitis.
We discuss what this skin condition is and what the symptoms are. You’ll learn what treatments exist, and what could be causing it. 
Symptoms of Folliculitis
Folliculitis and acne share similarities in that they both cause skin irritation and are the result of inflamed hair follicles. However, they are not identical.
Characteristic symptoms to watch out for include:
  • Itching.
  • Red pimples or pustules that may crust over.
  • Rash.
  • Painful, pus-filled boil or abscess under the skin.
The key difference between acne and folliculitis is in the location. Acne lesions tend to occur on the upper body: face, neck, back, and chest. Affected populations are usually adolescents or young adults. 
Contrastingly, folliculitis can manifest anywhere on your skin and can affect individuals of any age. Common areas are the neck, genitals, and groin.
Causes of Folliculitis 
Another feature that distinguishes this condition from acne is that it can be caused by external circumstances. Here are the typical triggers:
1. Hair Removal 
You may be familiar with the term razor burn, which is a type of traumatic folliculitis. 
When shaving against the grain—the direction your hair grows—it can result in ingrown hairs and hence, folliculitis. 
Similar methods, such as plucking and waxing, can also result in ingrown hairs if done incorrectly. This phenomenon is most likely to affect individuals with thicker, curlier hair. 
2. Friction
Chronic friction against the skin can inflame and irritate your hair follicles, especially when you’re sweating.
Obesity is a risk factor for this ailment, as excess flesh rubbing against itself can prompt irritation over time. Similarly, frequently rubbing or touching the skin can also prompt these eruptions.
Other potential sources of friction to watch out for include wearing tight clothing, or accessories that apply pressure to the skin such as backpacks. 
3. Bacteria, Viruses, or Fungi
Organisms such as viruses, bacteria, and fungi are other possible instigators of this usually benign condition.
  • Bacteria
Bacteria aggravating the hair follicle can cause bacterial folliculitis. 
If the infection is allowed to advance, you may develop a boil. This form of the disorder tends to impact the buttocks, armpits, and other sweat-prone areas that experience friction.
One of the most frequently reported infections is known as hot tub folliculitis, the result of exposure to species of bacteria that thrive within improperly-sanitized hot tubs.
  • Viruses
Certain viruses such as molluscum contagiosum (MC) herpes simplex virus (HSV) can cause folliculitis, although this is rare. 
Individuals with compromised immune systems who have these viruses are more at risk, e.g., people with human immunodeficiency virus (HIV).
  • Fungi
Malassezia (Pityrosporum) folliculitis is caused by an overgrowth of yeast on the skin. This type is most likely to be confused with acne, as it often appears on the upper body. 
4. Medications
Some medications can cause these itchy lesions as a side effect. Steroids are linked to acneiform eruptions—or acne-like lesions. 
Treatment
There is no universal treatment for folliculitis—it will depend on the severity and what is causing it. Here are our recommendations to get rid of this unsightly rash:
1. Stop Irritating It 
Assess your habits to determine if anything you’re doing could be worsening the lesions. Take care to avoid risk factors such as friction combined with excess sweating.
For example, if you go to the gym and wear tight shorts, shower immediately afterward to avoid worsening the lesions. Try gentler hair removal methods such as depilatory creams rather than razors, or take a break entirely while your skin heals.
Avoid scratching, picking, or rubbing at the rash or bumps. 
2. Keep Skin Clean and Dry
Take care to prevent the rash from festering—keep it clean and dry to avoid infection or worsening it.
Make sure that you wash it with a gentle soap without fragrances or other irritants, particularly after exerting yourself and sweating.
Don’t forget to change your towels and bedding on a regular basis. You shouldn’t be sharing towels with others when swimming, or using improperly sanitized hot tubs.
3. Anti-Inflammatories
If a large area is affected, or the inflammation is severe, you may experience pain. Non-prescription anti-inflammatory drugs, such as aspirin, can alleviate your discomfort and soothe inflammation.
4. Antibiotics 
This treatment method is for advanced or stubborn cases. Your dermatologist might prescribe a topical solution or oral medication, depending on the individual case.
Bacterial infections or deep folliculitis, in which a boil grows, are often treated with antibiotics. 
As Staphylococcus bacteria are the usual culprit, the antibiotics of choice are fluoroquinolone, penicillinase-resistant penicillins, or similar compounds. 
5. Minor Surgery
If antibiotics are ineffective against deep folliculitis, your dermatologist may suggest minor surgery. This is necessary if your boil has evolved into an abscess, in which skin tissue within the boil begins to die. 
The abscess must be lanced to allow the pus to drain it out of it. You may be required to stay in the hospital to remain on an antibiotic drip. 
6. Laser Hair Removal 
Although laser hair removal is a popular cosmetic procedure, it has medical uses as well. It can be a last-resort option against chronic folliculitis.
The procedure involves using targeted lasers to kill hair follicles and prevent hair regrowth. Laser hair removal has minimal complications and is an effective long-term treatment option for individuals who suffer from repeat occurrences. 
If you’ve been suffering from what appears to be acne with no relief, take a closer look. You can always consult with your dermatologist to be certain.
Treating folliculitis involves a different approach, meaning solutions for acne won’t work. If you have inflammation or infection, you may require medication for your skin to heal. 
If you suspect a bacterial infection, don’t ignore it. Abscesses can be extremely painful and require surgical intervention.
Ideally, you should take steps to prevent folliculitis from cropping up again. Identify what the cause was and try to avoid that behavior (e.g., hot-tubbing) in the future. 
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