1. Non-medical / home treatment
For mild folliculitis (taking into consideration that an underlying cause can be determined), the following care measures may help to clear up a breakout, relieving discomfort, preventing the spread of infection and promoting healing:
- Warm compresses: Warm, moist compresses or washcloths can be gently applied to the affected areas several times a day (for at least 20 minutes at a time) in order to alleviate tenderness and inflammation. Compresses will likely reduce itching and draw out any pus-filled bumps (drainage). A moistened compress soaked in a saltwater solution (1 teaspoon of salt in 2 cups of water) can help to soothe the skin and promote healing.
- Hygiene: Ensuring that infected skin is well cleansed can also help to keep the spread of a potential infection at bay. Skin can be gently washed twice a day with a mild antibacterial soap like hibiscrub, clean hands and warm / hot water, and a clean, soft washcloth (otherwise just the use of hands if a washcloth irritates the skin). Clean washcloths and towels should be used each time and should not be shared with anyone else. Clothing that is worn should be changed and washed regularly.
- Soothing baths: An oatmeal bath can help with reducing inflammation and soothing irritated skin. Oatmeal and oatmeal-based products are known to have anti-inflammatory properties. Alternatively, a cup of baking soda that is added to a warm bath may also help to alleviate symptoms. After a good soak, skin should be thoroughly dried with soft, clean towels.
- Skin protection: Whether caused or aggravated by shaving, plucking or waxing, it is best to stop these practices while the skin heals (sometimes it may be recommended that shaving or waxing be discontinued for up to 3 months so as to prevent ingrown hairs). Once shaving is resumed, using single blades or electric razors to shave only in the direction of the hair growth is advisable. Blades should be kept clean and sharp, and a non-irritating lubricant should also be used. Other causal irritants, such as cosmetics or ointments should also not be used while healing. Oil-free products can be used instead if these do not aggravate the condition during the initial treatment days. Loose clothing should be worn in order to lower the risks of friction. Cotton fabrics are often best. Measures to minimise heat, perspiration, constriction and friction should also be kept in mind in order to reduce skin aggravation.
2. Medical treatment
Infectious, chronic, recurring folliculitis or cases that do not resolve on their own may benefit from medical intervention. Treatment can help to clear a breakout, but cannot always guarantee that it won’t recur. Some treatments may be recommended for several weeks or months depending on the nature of the underlying cause and symptoms present.
Along with homecare measures, the following treatment options are available and may be recommended according to the underlying cause:
Treating infectious causes
Mild (or superficial) infections can be treated with antibacterial soaps and proper hygiene. In more severe instances prescription antibiotic creams, ointments, lotions or gels, or other antimicrobials may be recommended. Hydrocortisone creams can alleviate itching and swelling of irritated skin.
Severe or recurrent (bacterial) folliculitis may prompt a doctor to prescribe oral antibiotics. Antibiotic medications may be prescribed in courses of between 5 and 30 days (depending on the nature of infection), followed by maintenance antibacterial washes and topical ointments once an infection clears.
Anti-inflammatory medications / NSAIDs (non-steroidal anti-inflammatories) and antihistamines may also be recommended to ease symptoms (these are available over-the-counter for mild infections).
Antifungal creams, shampoos (for the scalp and or / beard) or oral medications may be recommended for yeast related folliculitis. Topical antifungal agents typically display few adverse effects, such as an allergic reaction, while actively working against dermatophytes.
A doctor may recommend antiviral agents for viral causes, often helping to clear symptoms by inhibiting viral replication within 10 days.
Treating environmental causes:
If folliculitis has been drug-induced, medications determined as a cause will be discontinued and others prescribed should they be necessary. Discontinuation and changing over to new medications must always be supervised by a medical doctor, and his or her directions carefully followed to avoid unwanted side-effects.
Antiseptic washes may be recommended for use (sometimes all over the body) on a regular basis, helping to reduce overgrowth of normal skin bacteria. This may be most helpful in instances where friction has caused hair follicle damage.
Treating non-specific causes
Steroidal creams to help soothe itching for eosinophilic folliculitis can help mild breakouts. These types of treatments may be recommended for specific time frames, so as to avoid overuse which can aggravate or potentially cause another folliculitis outbreak (or perioral dermatitis – skin inflammation around the mouth).
A patient with HIV experiencing eosinophilic folliculitis may also find some relief following a course of antiretroviral therapy.
Any recommended creams, lotions, ointments or gels that are used should be gently rubbed into (applied) the skin in the direction of hair follicles.
Minor surgery (lancing):
Large boils or carbuncles can be drained with minor incisions. This may be recommended to lessen severe pain and scarring of the skin tissue in the area by encouraging a quicker recovery period. Drained boils will be covered with sterile gauze dressings.
3. Other therapies
- Laser hair removal: Those who shave or wax may consider laser hair removal techniques for the long-term riddance of unwanted hair. This reduces the density of hair in the treated areas by removing hair follicles, and thus lessening the risk of re-infection or future inflammation. Several treatments may be necessary to see results, so expenses should also be taken into consideration. Blistering, skin discolouration and scarring can occur with these types of treatments, so they should be considered carefully for very sensitive skin. If all other treatment options fail, laser hair removal can be effective in combatting recurrent or persistent folliculitis.
- Light therapy: Photodynamic therapy (or light therapy) in combination with chemical solutions has been used for the treatment of acne, killing off bacteria, viruses or fungi on the skin. Some have found relief in using the same technique for the treatment of folliculitis symptoms.