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What is Folliculitis?
Folliculitis is a very common condition many men and women face on a daily basis. It is when hair follicles get irritated and inflamed and then red, pimple-like, bumps form. They can be painful and take days-weeks to resolve. Typically they occur in the groin area, buttock, thighs, and trunk. Sometimes the inflamed papules can also occur on the face (beard area) and the scalp, pretty much anywhere we have hair. These bumps can be very frustrating because not only are they bothersome when they are active but they can leave dark marks, called post-inflammatory hyperpigmentation, which can take months to resolve. When the inflammation is very deep it can lead to conditions such as: pseudofolliculitis barbae, acne keloidalis and hidradenitis suppurativa.
We will focus on the superficial forms of folliculitis as they are the most common. Athletes often struggle with folliculitis due to the clothing required for their sport, intense sweating, and repeated friction. Also folks that sit a lot (students, people with a desk job) are at increased risk for developing folliculitis.
Things that can aggravate folliculitis:
Friction (think of cyclists riding for miles and friction on the bicycle seat)
Occlusion (ointments and tight clothing)
Hair care (cutting hairs too short, waxing, shaving)
How to Treat and Prevent Folliculitis
We all have hair, it is difficult to completely avoid folliculitis. However, there are definitely habits and products that can help prevent, lessen and treat these annoying bumps.
First, let us address habits to help prevent/lessen folliculitis breakouts.
Spandex is not going to be a preferred fabric. You want to wear loose clothing as much as possible.
Hair care, clipping is recommended over shaving. However, if you are shaving, shaving with the grain of the hair is going to be much less irritating to the hair. Finally, if you are able to, laser hair removal is a very effective way to prevent folliculitis - you are removing the cause. Just remember, for laser hair removal to work - you need to have a dark terminal (thick) hair. Laser hair removal does not work on light, blonde, or red hair.
Skin care is essential to minimize folliculitis. You want to make sure you are cleansing the prone areas daily, we do not want bacteria to play a role in the inflammation. Using products to help minimize hair inflammation are very useful. You do not want to use pore-clogging products because that can cause the hair to become ingrown. Jojoba oil is one the best products to use on folliculitis-prone areas.
Don’t sit for long periods - make sure you get up and move around. The same is true for cyclists - make sure you get off your bike occasionally, give the skin a break from all the friction.
Second, we need a plan to treat folliculitis when it occurs to hopefully minimize any pain or subsequent hyperpigmentation.
Benzoyl peroxide wash is an excellent cleanser to use on folliculitis areas - this is one of my favorites for trunk and buttock. It may be a little harsh for the bikini line. The strength of benzoyl peroxide is something you need to be mindful of - if you have sensitive skin, I would recommend starting with 4-5% benzoyl peroxide. If your skin tolerates products well, 10% is the most effective dose.
Topical Clindamycin (typically 1%) can be a very effective treatment for folliculitis but it does require a prescription. It is used twice a day on active lesions and works to reduce inflammation while treating any bacteria that is worsening the inflammation. Some people use this daily as a preventative measure as well.
If there are painful lesions, often an intralesional injection of a steroid, like Kenalog, can be effective in bringing down the inflammation fast and help with the pain. This is recommended for non-infectious forms of folliculitis.
Finally, in severe cases, where the inflammation just happens all the time and is difficult to control with topical medications, oral antibiotics, specifically doxycycline, can be very helpful in reducing the inflammatory bumps. We do not want to get scarring from these bumps, that is permanent.
For the post-inflammatory hyperpigmentation, there are not a lot of treatments. Some people can have luck with hydroquinone but that can cause irritation in sensitive areas. Treating lesions right away and preventing the inflammation all together is the best thing to prevent the hyperpigmentation.
If you are struggling with folliculitis or any other skin conditions and would like to discuss skin care and treatment with a dermatologist, please come us at Aislyn Dermatology.
719-992-0127
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