Acne-like breakouts could be folliculitis

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Folliculitis caused by sitting in a hot tub.

What exactly is folliculitis?

This is a common skin infection that develops in the hair follicles. Folliculitis can appear anywhere on the skin, except for our palms and soles.

What does folliculitis look like?

It usually looks like a sudden acne breakout. Each spot may have a red ring around it, which is a sign of the infection.

What are the symptoms of folliculitis?

Symptoms can vary. You may not feel anything. Sometimes, the infection causes itchy skin. It’s also possible for your skin to feel painful.

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Also called pseudo folliculitis or razor bumps, men often see these on the beard area when they shave.

How did I get folliculitis?

You get folliculitis when you damage your hair follicles. Once damaged, it’s easy for germs to get inside the follicles and cause an infection. A common source of germs is Staph aureus, which is found on our skin. Other organisms on our skin can also cause an infection.

You can damage your hair follicles by:

  • Touching or rubbing your skin frequently
  • Wearing tight clothing
  • Having skin rub against skin
  • Shaving

When your skin is damp and hot, it’s easier to damage your hair follicles and get an infection. This can happen when tight clothing rubs against your skin while you’re bicycling on a hot day.

Many people get folliculitis from hot tubs. This is so common that there’s a condition called “hot tub folliculitis.”

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The damage can also happen while you’re using a hot tub or whirlpool. When this occurs, the acne-like breakouts tend to appear on skin that was covered by your bathing suit. Most people see breakouts about 12 to 48 hours after using the hot tub.

What causes folliculitis?

While many things can damage your hair follicles, the following are common causes of folliculitis:

  • Hot tub (improperly maintained)
  • Shaving, plucking, or waxing
  • Tight clothing or equipment
  • Medication applied to the skin, such as coal tar
  • Medication you take
  • Weight gain

How can I get rid of folliculitis?

The acne-like breakouts tend to go away on their own if you:

  • Have a healthy immune system
  • Stop doing what caused the folliculitis

To clear your skin more quickly and get relief, apply warm compresses to the area.  When using warm compresses, dermatologists recommend that you:

  • Apply a warm compress at least 3 to 4 times a day.
  • Leave the compress on your skin for 15 to 20 minutes each time.

If a warm compress helps you feel more comfortable, you can apply it more than 4 times a day.

When shaving, plucking, or waxing causes the infection, you’ll want to stop doing these things for 30 days.

Do I need to see a dermatologist about folliculitis?

It can be helpful to see a dermatologist to make sure you have folliculitis. The infected hair follicles can look like another skin condition, such as acne. A board-certified dermatologist can tell you whether you have folliculitis and give you tips to help clear it. Some people need medication, such as an antibiotic, to clear the folliculitis.

Seeing a dermatologist can also be helpful if you develop razor bumps from shaving and cannot stop shaving. Some men can continue shaving when they apply a medication to their skin. Your dermatologist can also give you tips that can reduce the irritation that shaving causes.

Can I prevent folliculitis?

Sometimes. Here are a few common causes and things you can do to prevent getting folliculitis:

Wear loose clothing when it’s hot and humid. Tight clothing tends to rub against your skin. When it’s hot and humid, the constant rubbing can injure your hair follicles, causing folliculitis. If you wear tight clothing while working out, you may be able to prevent a flare-up by changing out of your clothes immediately after working out and showering.

Use well-maintained hot tubs. You’re more likely to get folliculitis from a hot tub or whirlpool that’s improperly maintained. If you’re unsure whether the acid and chlorine levels are properly controlled, you may want to skip the hot tub or whirlpool. This will help you avoid getting hot tub folliculitis.

Wash your bathing suit or wetsuit after each use and let it dry. Washing your suit after each use and letting it dry completely before wearing it helps to reduce your exposure to bacteria that can cause folliculitis.

Follow these tips when applying medication to your skin. Some people develop folliculitis when they apply medication, such as coal tar, to their skin. You may reduce the risk of developing folliculitis by:

  • Applying the medication in the same direction in which your hair grows.
  • Not covering the treated area with a bandage or clothing, when possible.

Shave with care. Shaving is a common cause of folliculitis. You may be able to reduce your risk by following these shaving tips:

How to shave

While the acne-like breakouts of folliculitis tend to go away on their own, it can feel unsettling to suddenly see these appear on your skin. A board-certified dermatologist can tell you whether you have folliculitis and help you feel more comfortable.


Images
Images 1 and 2 used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Other images: Getty Images

References
Habif TP, Campbell JL, et al. “Folliculitis.” In: Dermatology DDxDeck. Mosby Elsevier, China, 2006: Card 48.

McMichael A, Guzman Sanchez D, et al. “Folliculitis and the follicular occlusion tetrad.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008: 517-9.

Yosipovitch G and Kwatra SG. “Itch associated with infections.” In: Living with itch: A patient’s guide.” The Johns Hopkins University Press. United States, 2013: 71-2.