Folliculitis (a.k.a. razor burn)
WHAT IS Folliculitis (a.k.a. Razor burn)?
Folliculitis is red bumps and pimples often on the scalp, neck, chest, back, and inner thighs. It is called razor burn when it happens after shaving. Folliculitis only happens in places you have hair. Folliculitis looks a bit like acne and usually improves with similar treatments.
WHAT causes Folliculitis?
We really don’t know why some people get folliculitis and others don’t when everyone has hair follicles. Sometimes extra skin bacteria get into a hair follicle (with shaving or by tight clothing or hats) causing a red bump or pimple.
Stress plays a role in folliculitis. You get more red bumps in your usual areas during a physical, mental, or emotional stressor. If I have a presentation or deadline, I end up with 3-4 new bumps on the back of my head.
How do I treat folliculitis?
Most people with folliculitis benefit from a few simple steps. You will need some trial and error to figure out which combination works best for you:
Medicated acne wash – I recommend benzoyl peroxide in a wash for the shower to simplify your routine. Almost every skincare company makes a benzoyl peroxide product, but remember: higher price ≠ better results. Also, stay at 5% or less, because 10% dries you out more without extra benefit.
My favorite medicated acne wash is CeraVe Acne Foaming Cream Cleanser (4% benzoyl peroxide). I also like AcneFree’s 2.5% wash.
Switch razors to a new Skinguard blade (or Venus’s version for women) if your folliculitis worsens with shaving.
Alcohol hand sanitizer – I love this simple step from a recently retired dermatologist. Keep a bottle of Purell hand sanitizer in the bathroom. Right after your daily shower, rub hand sanitizer on the areas where you usually get folliculitis. It dries within seconds and you can still style your hair or apply a good moisturizer over it. And, if you believe the label, it kills 99.99% of bacteria.
Hibiclens (chlorhexidine) wash – This is an antibacterial wash used in the operating room. It works best if you leave it on the skin for at least 5-10 minutes before rinsing off.
Use steroid (cortisone) ointments if it is itchy or red – Nothing works better to calm down the redness and irritation of folliculitis than steroids. An over-the-counter hydrocortisone ointment twice daily works best (instead of cream).
WARNING: Overuse of topical steroids like hydrocortisone can cause skin thinning, stretch marks, and easy bleeding or bruising.
Reduce stress: Like other chronic health conditions, folliculitis worsens with stress. This site has many simple, helpful tips for reducing stress. A big deadline at school or work, a difficult conversation, or an illness or death will make folliculitis worse. If you know a stressful event is coming up, treat your problem areas before they flare.
Eat healthier: When people with folliculitis eat poorly (fast food, junk food), their folliculitis flares. We eat worse when we are stressed. Reduce flares by switching as many meals as you can to whole-food, plant-based options.
Steps for using a medicated acne wash or Hibiclens:
First thing in the shower, rinse the areas where you get folliculitis with water.
Apply benzoyl peroxide wash or Hibiclens wash and leave it on for 5-10+ minutes for the medication to soak into your skin before rinsing off.
Benzoyl peroxide wash or Hibiclens can be used once or twice a day.
NOTE: Benzoyl peroxide will dry you out. Apply lots of moisturizing cream until your skin gets used to it. Also, benzoyl peroxide can bleach towels and clothing.
What if my folliculitis is caused by shaving?
If you get red bumps and pimples in areas you shave (face, neck, scalp, thighs, groin):
Pre-treat areas you shave with benzoyl peroxide wash or Hibiclens wash as described above before you shave.
Switch razors to one of the following: 1) new Skinguard blade (or Venus’s version for women), 2) single-use disposable razors (for women), or 3) an electric razor (simple or fancy) that doesn’t shave as close to the skin.
Put a little Hibiclens into a cup of warm water and soak your razor in this while you get ready for the day to kill bacteria left on your razor blades from shaving.
NOTE: Only soak your razor for 5 minutes – the water will rust your blades if you leave the razor in the Hibiclens soak all day. DO NOT shave with a rusty razor.
What if my folliculitis isn’t getting better?
The steps above can help most people get their folliculitis better. Sometimes prescription creams or antibiotic pills are needed, especially when severe or scarring. Sometimes folliculitis needs isotretinoin (known as Accutane). If over-the-counter options are not working, look for a board-certified dermatologist in your area. If you are in or near Utah, see one of my excellent colleagues at the University of Utah or me virtually with Honeydew.
DISCLAIMER
The statements expressed and content of this website are not intended to be a substitute for professional medical advice. Readers should seek their own professional counsel for any medical condition or before starting or altering any treatment, exercise, or dietary plan. Please see our full disclaimer here.