This is probably a blog post I should have done a long time ago, but it just seemed to make sense now after last week’s reader story from Elina.
So… there are other skin conditions that can look like acne.
Things like rosacea or eczema can sometimes resemble rashy acne, but in general, these can be treated holistically almost exactly like you’d treat acne.
However, there is something called folliculitis that looks a lot like acne, but treating it the same way may result in you banging your head against the wall.
What is Folliculitis?
Folliculitis is an infection of the hair follicles by either bacteria or yeast. It can result in red pustules with big puffy white heads, either on the body or on the face. Sounds like acne, right?
So what’s the actual difference? Acne is caused by bacteria, isn’t it?
Well yes and no. P. Acnes (the acne bacteria) is naturally found on the skin… there’s a lot of different things that go into the P. Acnes getting stuck in the pore and cause your body to react to it with acne.
This includes your body’s inflammation process determined by your lifestyle and hormones, the quality of your skin’s oil, irritation from skin care products, and a whole lot more.
In other words, acne bacteria isn’t really the root cause of acne. So if killing acne bacteria is your only strategy, it’s probably not going to pan out in the long run.
Folliculitis on the other hand is more like an introduction of a yeast or bacteria not normally found in your skin, and your body is having an acute reaction to that particular foreign pathogen.
This usually occurs because of something that’s been or had been rubbing or scraping your skin that allowed the bacteria to enter your skin – like razors, a scratchy shirt, a wet bathing suit. Although often it’s not at all obvious where you picked up the infection.
So, in the case of folliculitis, the yeast or bacteria actually is the root cause.
At least that’s how I understand it.
So the thing is, if you have folliculitis instead of acne, then the usual methods of treating acne might not work as well.
Not to say that improving your health wouldn’t be a good thing. Obviously the healthier you are, the easier your body can fight infection.
In fact, most mild cases of folliculitis will just clear up on their own once you stop whatever was irritating your skin and your immune system deals with it. Usually within a couple of weeks.
But in the case of chronic or widespread folliculitis, you may need a targeted medication to just kill the foreign pathogen, and then if all goes well, you won’t have problems anymore.
I’m not all that versed in the exact medications a doctor might prescribe for this, but it would either be a very short round of antibiotics or probably an oral or topical anti-fungal medication.
This is in contrast to acne, where I strongly recommend against the use of antibiotics. For acne, they kill the bacteria, but don’t at all address the root cause, and actually make the root causes worse (such as dysfunctional digestion).
This means when you stop, acne just comes right back and often worse.
How Do I Know if I Have Folliculitis or if I Have Acne?
Good question. It can be very tough to tell, since it looks a lot like acne and acne itself can have such a varied presentation, making it very confusing.
Some indications that it could be folliculitis include:
- It’s kind of rash like
- A lot of small pustules of the same size, and they aren’t so much filled with pus, but more like a clear fluid. These can drain and fill back up throughout the day.
- It gets worse with sweating and humid weather
- It’s itchy
- Shows up in a place of rubbing or irritation (especially if combined with moisture) – like where you shave, or under your backpack straps, or under your bra or sweaty T-shirt.
- The yeast variety often appears all over the chest and back (and is more likely to be itchy)
- Perhaps it came on suddenly
Now that I’m writing this, I’m wondering if I maybe had a bout of folliculitis myself. When I traveled to Australia when I was 18, I worked in Sydney for a while and had a very sweaty, synthetic work shirt.
Shortly after arriving, I suddenly came down with a very bad case of back acne, something I had never had before. I worked there for three months, and as soon as I left Sydney to continue traveling, the back acne cleared up almost instantly and has never returned.
I always thought this sudden and short lived back acne thing was quite mysterious, but maybe it was not actually acne, but folliculitis caused by the sweat and friction from that shirt!
Go Get Diagnosed
But anyway.. if you think you could have folliculitis, the first thing you want to do is remove any factors that could be causing irritation and contributing to the problem, like that sweaty shirt. This also isn’t a bad idea if it’s acne!
If you have no luck on it clearing, the only way to really know for sure if it’s folliculitis is go to the doctor or dermatologist and get it diagnosed.
If it is folliculitis, how you treat it will depend on whether it was caused by bacteria or yeast. The bacteria kind is more common, but if you have the yeast kind, a round of antibiotics might not help.
If you can, insist they test you to find out which kind it is.
Do you have any experience with folliculitis? Please share your tips and strategies! I’m especially interested to know if anyone has used an effective natural treatment for folliculitis (instead of antibiotics)