At first glance, those pesky red bumps on your skin might look like acne, but what if they’re not? If you’ve ever treated what you thought was acne only to find no improvement, there’s a chance you’re dealing with something else entirely: folliculitis. While both conditions involve inflammation and can appear similar, they are not the same. Understanding the difference can lead to faster, more effective treatment and fewer flare-ups in the future.
What Is Folliculitis?
Folliculitis is essentially an inflammation of the hair follicles. Each hair on your body grows out of a follicle, and when these become infected or irritated, usually by bacteria, yeast, or even friction, you end up with red, pimple-like bumps that can be itchy or painful. According to the American Academy of Dermatology (n.d.), common causes include shaving, sweating, tight clothing, hot tubs, and certain medications.
Folliculitis is often triggered by Staphylococcus aureus, but in some cases, Pseudomonas aeruginosa or fungal organisms are the culprits (Lee & Yosipovitch, 2011). It doesn’t just affect the face. Folliculitis often shows up on the thighs, buttocks, chest, back, or scalp. It may look like acne, but the causes and treatments differ significantly.
What Is Acne?
Acne is a chronic inflammatory skin condition that occurs when pores become clogged with oil (sebum), dead skin cells, and sometimes bacteria. Unlike folliculitis, acne has different forms such as whiteheads, blackheads, papules, pustules, nodules, and cysts. It tends to persist longer and is often influenced by hormones, diet, stress, and genetics (Zaenglein et al., 2016).
Research shows that Cutibacterium acnes (formerly Propionibacterium acnes) plays a significant role in the inflammatory response seen in acne (Dreno et al., 2018). While acne is common during adolescence, it can persist into adulthood and typically appears on the face, chest, shoulders, and back. It is not contagious. In contrast, some forms of folliculitis, particularly bacterial or fungal types, can spread through shared towels, razors, or hot tubs.
How to Tell the Difference
So how do you know which one you’re dealing with? Here are a few key distinctions:
| Feature | Folliculitis | Acne |
|---|---|---|
| Appearance | Small red or white bumps with a hair in the center | Varies: blackheads, whiteheads, papules, cysts |
| Location | Often on thighs, buttocks, scalp, beard area | Common on face, chest, back |
| Itching or Pain | Often itchy or sore to the touch | May or may not itch, more painful with cystic types |
| Triggers | Shaving, sweating, friction, hot tubs | Hormones, oil production, clogged pores, stress |
| Infectious? | Sometimes, especially bacterial or fungal | No |
If your skin outbreak gets worse after shaving or wearing tight clothes, folliculitis could be the culprit. On the other hand, if you’ve battled skin issues since your teens or during hormonal changes, you might be dealing with acne.
Treating Folliculitis
Treatment for folliculitis often starts with identifying and removing the trigger. For example, switching to a clean razor, wearing looser clothing, or avoiding hot tubs can help. Mild cases may clear up on their own, but more persistent ones might need:
- Topical antibiotics such as mupirocin
- Antibacterial washes such as benzoyl peroxide or chlorhexidine
- Antifungal creams if yeast is the cause
- Oral antibiotics or antifungals for more severe or widespread cases
Good hygiene plays a crucial role. It is also important not to over-cleanse or scrub, which can irritate the skin further. According to Elston and Stratman (2020), managing underlying conditions like diabetes or immune deficiencies can also improve treatment outcomes.
Treating Acne
When it comes to acne, a consistent skincare routine is key. The approach depends on the severity and type of acne but may include:
- Topical retinoids to unclog pores and promote cell turnover
- Benzoyl peroxide to target acne-causing bacteria
- Salicylic acid to exfoliate and reduce inflammation
- Oral medications, including antibiotics, hormonal treatments like birth control pills, or isotretinoin for severe cases (Zaenglein et al., 2016)
Studies also suggest a connection between high glycemic diets and increased acne severity, making dietary changes an effective supplementary strategy (Smith et al., 2007). Lifestyle adjustments, such as reducing sugar intake, managing stress, and avoiding picking at blemishes, can also make a noticeable difference.
When to See a Dermatologist
If you are unsure whether you are dealing with folliculitis or acne, or if your skin is not responding to over-the-counter treatments, it is time to see a dermatologist. A skin professional can perform a culture test, especially useful in suspected bacterial or fungal folliculitis, and prescribe tailored treatment options.
It is easy to misdiagnose your skin issues, especially when folliculitis and acne look alike on the surface. But their root causes and effective treatments are quite different. Being able to distinguish between the two empowers you to take the right steps and avoid the frustration of trial-and-error skincare. And remember, you are not alone. Both conditions are common, treatable, and nothing to be embarrassed about.
References
- American Academy of Dermatology. (n.d.). Folliculitis: Diagnosis and treatment. Retrieved from https://www.aad.org
- Dreno, B., Pecastaings, S., Corvec, S., Veraldi, S., Khammari, A., & Roques, C. (2018). Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: A brief look at the latest updates. Journal of the European Academy of Dermatology and Venereology, 32(S2), 5–14. https://doi.org/10.1111/jdv.14820
- Elston, D. M., & Stratman, E. J. (2020). Folliculitis: Pathogenesis, clinical features, and diagnosis. UpToDate. Retrieved from https://www.uptodate.com
- Lee, M. R., & Yosipovitch, G. (2011). The role of skin barrier in the pathogenesis of folliculitis. Dermatologic Clinics, 29(1), 1–7. https://doi.org/10.1016/j.det.2010.08.001
- Smith, R. N., Mann, N. J., Braue, A., Mäkeläinen, H., & Varigos, G. A. (2007). A low-glycemic-load diet improves symptoms in acne vulgaris patients: A randomized controlled trial. American Journal of Clinical Nutrition, 86(1), 107–115. https://doi.org/10.1093/ajcn/86.1.107
- Zaenglein, A. L., Pathy, A. L., Schlosser, B. J., Alikhan, A., Baldwin, H. E., Berson, D. S., … & Bhushan, R. (2016). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 74(5), 945–973.e33. https://doi.org/10.1016/j.jaad.2015.12.037
