How to Know Whether Your Breakout Is Actually Folliculitis

Maybe they were staring back at you from the mirror as you began your morning skincare routine, or perhaps your hand grazed them as you were sudsing up in the shower: fresh new pimples. Though it's easy to blame any new spot on acne, sometimes it's not actually the culprit. Enter folliculitis.

Inflamed hair follicles can stem from a host of everyday activities, and can be difficult to tell apart from everyday acne. Fortunately, there are many ways to treat folliculitis and even some tricks on avoiding it altogether. 

Ahead, doctors tell us everything you need to know about folliculitis.

What is Folliculitis?

Folliculitis, simply put, is inflammation of the hair follicle. And, since most of our bodies are covered in hair follicles, it can show up just about anywhere. Besides the palms of your hands, soles of your feet, and lips, folliculitis can occur anywhere else on your body where there is hair, explains New York City-based board-certified dermatologist Marie Hayag, MD. "Most commonly, it appears on the arms, legs, back, buttocks, and the groin area."

Causes

From shaving with a soiled or old razor or spending time in a hot tub, our hair follicles can get angry pretty easily—folliculitis is very common. Sweat, bacteria, yeast, and even dry skin are all common factors.  

Annoyingly, even the simplest things like rubbing or friction from sitting too long or wearing tight clothes can trigger folliculitis. Dermatologists note that it is widespread in cyclists due to sitting on a bike for extended periods of time.

Types of Folliculitis

Confusion occurs because a. Folliculitis can be indistinguishable from a standard acne breakout, and b. There is more than one kind of folliculitis. New York City-based board-certified dermatologist Nikhil Dhingra, MD, likes to break it down into two categories: sterile and infection. 

1. Sterile folliculitis often results from improper shaving cream—for example, shaving without shaving cream or using a dull razor. Tight-fitting clothes, workout gear worn (and sweat in) for too long, and oil clogging the hair follicles can all result in sterile folliculitis.
2. Infectious folliculitis, on the other hand, is bacterial. “Usually, it results from staph bacteria, which is very common on our skin, or acne-causing bacteria which can also infect the hair follicles,” Dhingra explains. Occasionally, it can be viral (this is rare but can occur with viruses like herpes) or fungal (often it spreads from areas like the feet).

How Folliculitis Differs From Acne

Sometimes, it’s really undetectable—especially to the untrained eye, and you’ll want to consult a board-certified dermatologist to make sure you know what you’re dealing with (and can treat it accordingly). But, if you’re trying to figure it out for yourself, New York City-based board-certified dermatologist Ellen Marmur, MD, suggests looking for damage to the hair follicle (which will show up as redness, irritation, and inflammation). Some other signs of folliculitis include spots with red rings around them or small red bumps or whiteheads. Confusingly, pus, painful red bumps, and cyst-like areas can feature folliculitis and a standard acne breakout.

If you see a board-certified dermatologist, they can do a bacterial swab, which can potentially identify the type of bacteria triggering the breakout, explains New York City-based board-certified dermatologist Marisa Garshick MD. "It is sent to a lab and can determine what specific type of bacterial organism may be contributing to folliculitis and can often guide treatment based on what medications would be most helpful for the specific bacteria," she says.

Treating Folliculitis 

Though folliculitis does often go away on its own, if it gets painful, you should see a board-certified dermatologist. These are some common methods of treatment:

• Oral and/or topical antibiotics: According to Marmur, dermatologists will likely prescribe oral or topical antibiotics or anti-fungal medication. "In some cases, the doctor may also prescribe an antihistamine for the itching.” 
• Antibacterial cleanser: Using a cleanser with benzoyl peroxide (like Humane Face & Body Acne Wash) can help, Dhingra notes. He sometimes recommends Hibiclens, an antibacterial wash that he notes should be used sparingly in less sensitive areas and not on the face or genitals.
• Laser hair removal: Laser hair removal, while expensive, can offer a permanent solution to folliculitis. By shrinking the hair follicles, the density of hair that grows in an area is drastically and permanently reduced, eliminating the possibility of them becoming inflamed. 
• Taking a hands-off approach: It is essential never to pop these spots like pimples, Marmur says, as doing so can lead to a bad staph infection. 

How to Prevent It

Luckily, there are simple lifestyle changes you can make that help avoid folliculitis before it occurs:

• Exfoliate often—but only with a chemical exfoliant, as physical exfoliants can make folliculitis worse. If you know you’re prone to folliculitis, make sure to exfoliate in those areas.
• Wear wicking fabrics, and shower and change out of workout clothes as soon as possible after exercising or sweating.
• Try a standing desk to avoid sitting for too long.
• Use non-comedogenic products.