What is the treatment for folliculitis?
Wherever the folliculitis occurs, the treatment principle is broadly the same. General measures involve avoiding things that aggravate the condition. It is important to shave in the direction of hair growth. Sometimes it is worth taking a break from shaving for a few days, to let the folliculitis settle down by itself. Tight clothing over the affected area, particularly if it makes you sweat, will not help either. Keeping cool and keeping folliculitis exposed to the fresh air will also help. If you have folliculitis you should not share towels, flannels or razors.
Most cases or folliculitis are mild and do not need any treatment. It often clears without any treatment within 7-10 days. It may be helpful to use a moisturiser (emollient) which contains an antibacterial agent - for example, Dermol® cream or lotion or Emulsiderm®. This will improve the condition of the skin and soothe it. It may help the folliculitis to clear more quickly and reduce the risk of it becoming worse. You can use one of these emollients as a soap substitute until the folliculitis has cleared. Specific preparations for the bath or shower are available - for example, Dermol® 200 Shower Emollient, Dermol 600® Bath Emollient and Oilatum® Plus bath additive.
If simple measures over a few days do not allow the folliculitis to improve, you should probably see your GP for further advice and treatment.
For localised areas of folliculitis, an antibiotic cream may be useful. Fusidic acid is a suitable antibiotic cream that can be applied 3-4 times per day to affected areas.
More severe cases
If the folliculitis is more severe or widespread then a course of antibiotic tablets may be needed.
Recurrent or long-term (chronic) folliculitis
Recurrent folliculitis occurs when the infection keeps coming back, although it disappears with treatment. The gaps between episodes may get shorter and, eventually, chronic folliculitis is the result. In these cases, your GP may take a sample (swab) from the skin where the folliculitis is. This swab can show what germs (bacteria) are responsible for the infection. If the swab confirms S. aureus, it is a good idea to take some more swabs, usually from the nose, to see if you are a carrier of this germ (bacterium).
If you do carry staphylococci in the nose and you get recurrent folliculitis (or if you have chronic folliculitis), this is likely to be the reason behind it. Treatment is to destroy (eradicate) the staphylococci and prevent further folliculitis. This will usually involve three forms of treatment to be used at the same time. First, a course of antibiotic tablets. Second, a course of an antibiotic nasal cream. Because the staphylococci may also be on other parts of the body, not just where the folliculitis is, it is also advisable to use an antiseptic skin wash or shower gel. Products containing chlorhexidine (for example, Hibiscrub® 4% solution or Hydrex® 4% surgical scrub) or Ster-Zac Bath Concentrate®) are suitable. You should also launder clothing, bed linens and towels on a hot wash. This will prevent you getting re-infection and also reduce the risk of passing the infection to others. Finally, you will need to have repeat swabs to confirm that you are clear of the bacteria - three clear swabs over a three-week period will confirm the staphylococcal infection has been eradicated.
How can folliculitis be prevented?
Keeping your skin clean, dry and free from abrasions or irritations can help to prevent folliculitis. Certain people are more prone to infections, such as people with diabetes. If you have a medical problem that makes you more likely to get infections, these precautions may be more important. Using antiseptic washes routinely is not generally recommended, as they can make the skin sore and dry. Keeping the skin moisturised can help protect it from damage. Take care when shaving (especially if you wet shave), using a shaving gel, foam or soap to lubricate the blades across the skin and prevent nicks and cuts.
Most cases of folliculitis are not contagious but if you have been identified as carrying the S. aureus germ (bacterium), this infection can occasionally be transferred to other people. This risk can be minimised by normal hygiene measures and laundering clothing, bed linens and towels on a hot wash. Do not share razors. You should also avoid sharing hot tubs and Jacuzzis® until the infection has been treated.