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.
And if you do end up taking antibiotics, ensure that you are taking good probiotics before, during, and after to prevent gut imbalances.
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)
Now when I think about it… my folliculitis misery started after a couple of months when I had used antibiotics (to cure urinary infection). So I think folliculitis is caused by internal imbalance, in the gut flora….and that it is nothing outside that is causing folliculitis, but there’s some imbalance in the body and then skin reacts unnormally strongly to these normal external things, like sweat and sweating?
Once again, amazing to see how profound effect this healthy bacteria and balance in the gut have to everything! I’ve also read that it takes 1,5 years for the gut to restore balance (which was disturbed by the antibiotics). Amazing also, that this all was about 1,5-2 years ago…and now my skin indeed seems to be ok, no itchy pimples and skin is not “over reacting” anymore. What a relief 🙂
So, healing takes time…But with active folliculitis, I do recommend visiting a doctor and medication (that gives a quick relief), I mean the itching can be unbearable!! 🙁
Hi Elina, yes itchy, rashy skin conditions are definitely linked to gut imbalance. So is acne… so maybe acne and folliculitis aren’t treated so differently in that regard!
I am still not 100% sure if this was folliculitis, but after a lot of Googling and research, I realized that the thousands of tiny bumps on my forehead was probably something called pityrosporum folliculitis. Lots of people had successes treating it with multiple things: tea tree oil, oil of oregano, apple cider vinegar, dandruff shampoo, etc.
I realized that since this was probably caused by a buildup of yeast, that maybe I should cut back on the gluten, alcohol, and sweets, since yeast feeds off sugar. This helped a little with the redness and inflammation, but the bumps were still there, so I kept trying. I tried rubbing Nizoral, a dandruff shampoo that contains Ketoconazole, on my forehead each night for 10 nights to see what happened. It completely, 100% cleared up. I was shocked and sooo happy. I guess that ingredient is supposed to be really helpful in killing the “fungus” or yeast that this stuff is made of.
The thing is, once I stopped using it regularly, it came back. So, probably a quick fix and not a solution. I would suggest going on a low-to-no sugar diet and trying out the more natural solutions like tea tree oil or ACV. Tea tree oil does help with the inflammation.
Sorry that was a novel. Hope it helps some people!
Great suggestions, thanks for sharing Angela!
Hi! I have the wonderful German heritage heavy peach fuzz that takes over the bottom half of my face and all of my neck. I think I might have recently irritated this skin in attempting to remove hair with a women’s facial razor, but it’s more of deep cystic type of acne. Any thoughts on if this could be folliculitis or just hormonal? Also, I’d appreciate any advice on facial hair removal! Thanks in advance xxx
Hi Libby, is this a new thing? like this just came on suddenly? If it’s big cystic acne, that doesn’t sound so much like folliculitis… but I don’t know! Hair removal, unfortunately I’m not versed in best ways to do so without irritating the skin
Hi Tracy! It’s a new thing, but I also have a significant amount of stress that has also increased recently (job, relationship, the works!), so that’s more likely the main contributing factor. Hair removal is difficult without triggering a negative skin response, but I’m cutting back on the hair removal til things heal up (especially on my neck). Thanks for your response 🙂
Great post! I was not familiar with folliculitis at all. Thanks for clearing things up Tracy!
This is so interesting! And extremely helpful. I have dealt with folliculitis in my underarms on and off and I wonder if some of the acne on my back could be the same thing. I especially tend to get it under my bra strap and on my lower back that are kind of itchy and don’t follow the same pattern I have seen elsewhere. This is definitely something I will explore further. Thanks for a great post!
I am 50, started breaking out with acne at the tender age of 8 1/2, had very oily skin, was prescribed “Accutane” twice, was diagnosed with seborrheic dermatitis on my scalp in my early twenties (but suspect I had it in my teens too), and was prone to folliculitis on the scalp. Each time I was prescribed antibiotic. It happened whenever I drank too much pepsi, sweets, was stressed out, or hot and humid weather. It was very frustrating! I didn’t understand the cause and just kept on taking antibiotics for it, washing my hair frequently, and not using conditioner which I was told clogged my follicles (I have very thick, wavy hair which has a tendency to be dry and oily, angry scalp prone to flare ups due to the SD. I think I have a very severe case of it.). Back then, I didn’t understand about gut health, antibiotics, or nutrition would help. Even at 50, I’m still learning. It annoys me LOL that even at my age my face is still oily, still breaks out especially around cycle time, and I still get flare ups of the SD which are very painful. Someone told me I might have an intolerance to dairy or gluten or maybe both. I also was diagnosed with endometriosis stage four in my forties and we couldn’t have children. What really helps is limiting sugar, dairy,and gluten, using an all natural tea tree and neem shampoo bar, and a braggs cider vinegar rinse diluted with water as a rinse. I was thinking of writing an ebook on what I have learned and what works for me. Would anybody be interested? I just want to help people. Thanks!
I would be very interested Maria!!! I too have endometriosis and so many problems with facial skin and scalp. Good luck and happy new year, great article too Tracey
Hi you two. (Not sure if either of you will see this). I’m a guy in my mid 20s, and I’ve had greasy skin for years which has always caused acne. I’ve been on accutane once, and it worked, but a few months later my skin grew oily again. I also cut out dairy completely, limited my gluten intake, drank daily acv or coconut vinegar with water, and avoided excess hair and face washing (and any product with inflammatory ingredients.) But none of that helped my greasy skin. By accident, I stumbled upon something called Pantothenic acid (aka vitamin b5.) You can buy 500mg/pill 100 pill bottles from gnc for about $12 or buy in bulk from from superior nutraceuticals (be warned, the bulk powder tastes disgusting)…but I digress. These things work for people with greasy skin. Bad flare-ups are eliminated in about 2-3 days by taking 8 grams (that’s 16 pills) once a day…and after clear up, I take 3-4 grams daily for maintenance. It’s somewhat controversial as an acne treatment (read up on it — men report hair loss, and it can affect women on birth control, cause anxiety, and poor sleep — I have yet to experience any of those symptoms and it’s been over 2 years since I started using it.)But there have been studies on its benefits, when taken internally (to reduce excess skin oil production,) and when applied externally. I do both, and it has been the only consistent product I actually use (aside from a nighttime moisturizer.) I can’t recommend it enough.
I should mention that I found Tracy’s blog about 4 years ago, and of course I advocate her recommendations and to take a healthy lifestyle (eliminating processed foods, eating healthy, exercise, water, etc.) but for people with naturally hyper oily skin, this was seriously a life saver. (Confidence, comfort, you name it, I’m effectively acne free unless I shave too quickly.) I’m posting this on the folliculitus page because I had it on my neck not to long ago, but found that the pantothenic acid wasn’t helping it (unlike my facial acne), and that I needed to get a topical anti-fungral prescription. But then I saw your comments about oily skin…so I thought I’d but in like the busibody I am.
Anyways, hope this helps you ladies. Pantothenic acid/b5 is available many places, from vitamin shoppes, to gnc stores, to rite-aids, and if it works as it did for me, you’ll notice your oil production evening and acne disappearing in about a week (from 8gram+ dosing.) (You can also crack a capsule pill, mix with water, and apply it to the skin as a mask to accelerate the process.) If that doesn’t help you….well, then I’d advice against taking it, as large doses do cause minor stomach upset (but at this point my body is used to that amount and it doesn’t affect me, but I still get the benefits.)
Yes,I’m interested , I’m suffering with chronic folliculitis on my back, chest, neck, and now even on my face !! I’m been taking an antibiotic called doxycycline which one type of antibiotic to treat acne, for two weeks, it doesn’t help ,instead my folliculitis getting worse . Appreciate you may share your solution to my email firstname.lastname@example.org.
I’m not a doctor and never visited a doctor because of my folliculitis, but I’m not sure if antibiotics is the correct cure to this disease? Ironically, I feel that for me the antibiotics are the root cause that caused me the folliculitis in the first place! I originally used antibiotics to treat urinary infection and the folliculitis started a couple of months later. Summer and humidity made the folliculitis worse, but I think they are not what actually cause folliculitis. I think antibiotics caused imbalance to the gut/whole body and that’s why my skin also became imbalanced.
I treated it with Nizoral, it’s actually shampoo that is made to treat dandruff, but I used it as a body wash. It helped to relieve symptoms, but not really cure it. Interestingly, when I had the folliculitis at its worse; I was in a very bad and toxic relationship. Sometimes I think, if this kind of skin diseases develop unconsciously, like it was building a “wall” around my body, that says “stay away from me!”. I worked with an energy/spiritual healer to these relationship issues, and to my surprise, my skin has improved a lot. I also took many months Kyolic capsules. These are made of garlic, but they are much more stronger than plain garlic (and no odour!). They have been scientifically proven to kill bacteria, viruses, fungi and improve immunity.
So, nowadays, I have no folliculitis at all! It’s a mysterious skin disease. I think I’ll never know if these things I mentioned cured it, or if it’s something that the body cures by itself with time, when my gut and over all health and immunity improved.