Definition
What is Folliculitis and body acne?
Folliculitis is inflammation of the hair follicles. It shows up as small red bumps or pustules with white-yellow centers around the hair follicle. It can develop anywhere on the body where there is hair; in women it's most common on the legs, bikini area, underarms, buttocks, back and chest. Many of the red dots that appear after waxing, shaving or using an epilator are also folliculitis or a similar ingrown-hair reaction.
Folliculitis doesn't have a single cause. Bacteria are most often responsible; however, in some cases an overgrowth of a yeast already present in the skin's natural flora causes it. Yeast-related folliculitis (Malassezia folliculitis, often called 'fungal acne') appears as itchy, uniform small bumps, especially on the upper back, chest and hairline, and is frequently mistaken for acne. There are also types linked to hot tub water, tight clothing, sweating or shaving-related ingrown hairs.
What we call 'body acne', the breakouts on the chest and back, forms when oil glands become clogged and can overlap with folliculitis. That's why some women who use acne creams for months without results actually have a different underlying cause. Once the right diagnosis is made, treatment often works surprisingly quickly.
Check yourself
How do you recognise it?
- ✓Small red bumps around hair follicles
- ✓Small pus-filled pustules with white or yellow centers
- ✓Clusters of uniform bumps of the same size (common in the yeast-related type)
- ✓Itching or a burning sensation
- ✓Red dots that start 1-3 days after waxing, shaving or epilating
- ✓Hard, painful ingrown hairs where the tip of the hair curls under the skin
- ✓Acne-like breakouts on the upper back, shoulders and chest
- ✓Flaring with exercise, sweating or hot weather
- ✓Brown spots where bumps have healed
- ✓Painful, swollen, warm boils when the infection goes deeper
Why it happens
Main causes
01
Bacterial folliculitis
This is the most common type. It shows up as small pus-filled pustules around the hair follicle. Mild cases may clear on their own; widespread or recurring cases need a dermatologist's evaluation.
02
Yeast-related folliculitis
It forms when yeast in the skin's normal flora overgrows. Itchy, uniform bumps appear on the back, chest and hairline. A study of 320 patients diagnosed with acne showed that 28.8% of them also had this condition.
03
Ingrown hairs after shaving and waxing
As the sharp tip of a cut hair grows, it re-enters the skin and triggers a foreign-body reaction. It's more common with curly, coarse hair. This isn't an infection but an inflammatory reaction; however, an infection can develop on top of it.
04
Hormonal body acne
Under the influence of androgen hormones, oil glands produce more oil; the dense oil glands on the back and chest become clogged and form pimples. Breakouts that fluctuate with your menstrual cycle and appear on both the chin and back may point to a hormonal origin.
05
Hot tub folliculitis
A bacterium that multiplies in poorly chlorinated hot water can cause itchy red bumps in areas covered by your swimsuit. It usually starts 1-2 days after using the pool or hot tub.
06
Immune and medication effects
Diabetes, conditions that suppress immunity, and long-term use of antibiotics or cortisone can increase the tendency toward folliculitis.
In daily life
Triggers that cause flare-ups
Medical approach
Treatment options
01
The right diagnosis: bacteria or yeast?
This is the most important step in deciding the direction of treatment. Your dermatologist can identify the cause by examining a sample from a bump under the microscope or with a culture. Even a simple smear test often clarifies the diagnosis.
02
For bacterial folliculitis
In mild cases, your dermatologist may recommend antiseptic washes or a topical antibiotic. Widespread or deep involvement may require oral antibiotics. In recurring cases, nasal carriage of bacteria may also be checked.
03
For yeast-related folliculitis
The Danish Dermatological Society's guideline states that for this type, oral antifungal treatment is probably more effective than topical treatment, and that using both together may be advantageous. To reduce recurrence, your dermatologist may recommend maintenance antifungal shampoos or lotions at set intervals.
04
For body acne
Washes containing benzoyl peroxide and salicylic acid, topical retinoids or azelaic acid can be used after your dermatologist's assessment. If there's a clear hormonal component, hormone-regulating options may be considered together with your OB-GYN.
05
For ingrown hairs and shaving folliculitis
The most effective approach is reducing the trigger: taking a break from shaving for a while, changing your technique or considering laser hair removal. Because laser reduces hair follicles, it can be a long-term solution for recurring cases.
06
Caring for spots and marks
For brown spots left where bumps have healed, your dermatologist may recommend brightening ingredients such as azelaic acid and niacinamide, or a chemical peel. Protecting the skin from the sun helps keep the spots from becoming permanent.
Did you know? · Folliculitis and body acne
18.5% · A study of 264 folliculitis patients in Adana, Turkey, found that 18.5% of cases were caused by yeast rather than bacteria.
Step by step
Care routine for Folliculitis and body acne
- 1
Pre-workout prep
If you're going to exercise, choose breathable, loose-fitting clothes in cotton or technical fabric.
- 2
Light cleansing
Wash your back and chest with a low-pH, fragrance-free body wash.
- 3
Targeted wash
If your dermatologist recommended it, leave a salicylic acid or benzoyl peroxide wash on for 1-2 minutes, then rinse. Benzoyl peroxide can bleach towels and clothes.
- 4
Light hydration
Instead of oily, heavy creams, use a non-comedogenic moisturizer with a gel or lotion texture.
- 5
Sun protection
Apply a lightweight sunscreen to any exposed back and chest; it helps reduce lingering marks.
Caution
What to avoid, and when to see a doctor?
Avoid these
- ✕Squeezing or popping the bumps
- ✕Shaving against the grain and on dry skin
- ✕Dull or shared razors
- ✕Staying in sweaty workout clothes for a long time
- ✕Using antibiotic creams for a long time without a diagnosis
- ✕Applying heavy body oils to your back and chest
- ✕Synthetic, tight, non-breathable clothing
- ✕Scrubbing hard with an exfoliating mitt
See a dermatologist
- →If the bumps last more than 2 weeks or are spreading
- →If a painful, swollen, warm boil or abscess has formed
- →If you have a fever, feel unwell or the redness is spreading quickly
- →If an itchy back and chest rash doesn't clear despite acne treatment
- →If it keeps coming back or you have a condition that affects immunity, such as diabetes
- →If permanent spots, pitted scars or keloids form in healed areas
Common misconceptions
Myth or fact?
Myth
Every bump on your back is a pimple.
Fact
No. Some are yeast-related folliculitis and don't respond to classic acne treatments; itching and bumps that look very much alike are an important clue.
Myth
Red dots after waxing come from dirty wax.
Fact
They're usually due to mechanical irritation of the hair follicle and ingrown hairs. Hygiene matters, but the real deciding factor is how much stress the hair follicle is put under.
Myth
The more I wash, the faster it clears.
Fact
Excessive, harsh washing disrupts the barrier, throws off the microbiome's balance and increases irritation. Gentle cleansing once or twice a day is enough.
Popular searches
Most asked about Folliculitis and body acne
Your questions
Frequently asked questions
Is folliculitis contagious?+
Bacterial folliculitis can, though rarely, spread through shared towels, razors and loofahs. That's why not sharing personal items is a good habit. The yeast-related and shaving-related types aren't contagious.
How can I tell if it's caused by yeast?+
Itching, small bumps that look very much alike, and placement on the upper back, chest and hairline are important clues. A definite diagnosis requires your dermatologist to do a simple microscopic exam.
Which is better: waxing, shaving or laser?+
If you deal with recurring folliculitis and ingrown hairs, laser hair removal is the least triggering option in the long run because it reduces hair follicles. If you shave, technique is what matters; if you wax, aftercare is what matters.
Why does my back acne change with my cycle?+
Hormone fluctuations throughout your cycle affect how your oil glands work. Back and chin breakouts that flare before your period may point to a hormonal component; in that case, an evaluation by your OB-GYN can also be helpful.
How long does it take to clear?+
Mild shaving folliculitis may clear within a few days once the trigger is removed. With a correct diagnosis and appropriate treatment, bacterial or yeast-related folliculitis usually improves noticeably within 2-4 weeks; it takes longer for the spots to fade.
What should I watch out for at the gym?+
Put a towel between the equipment and your skin, shower as soon as possible after your workout and change out of sweaty clothes right away. These simple steps noticeably reduce flare-ups caused by sweat and friction.
Why do I get acne on my back?+
In women, the most common causes of back acne are body acne from clogged oil glands, yeast-related folliculitis, friction made worse by sweat and tight clothing, and conditioner residue left on the back. If it fluctuates with your menstrual cycle, a hormonal component is also considered. Itchy, small bumps that look very much alike may point to yeast.
How do I get rid of red dots on my legs?+
Red dots that appear after shaving or waxing are usually shaving folliculitis or ingrown hairs. Taking a few days off from shaving, using a sharp, clean razor, shaving softened skin in the direction of hair growth and exfoliating once or twice a week with a salicylic or lactic acid lotion works for most people. See a dermatologist for dots that are pus-filled, painful or spreading.
What helps with bumps after waxing?+
For 1-2 days after waxing, avoid hot showers, saunas, tight clothing and heavy, oily creams; keep the area clean without touching it. A fragrance-free, light soothing lotion and gentle chemical exfoliation in the following days reduce ingrown hairs. If it keeps happening, laser hair removal can reduce the trigger in the long run.
How do I fade folliculitis marks and back acne spots?+
Brown spots left where bumps have healed usually fade over time; protecting your skin from the sun supports this process. Your dermatologist may recommend brightening ingredients such as azelaic acid and niacinamide, or a chemical peel. Fading can take months; preventing new bumps is also part of preventing new spots.
Scientific basis
Sources
- 1.Epidemiological characteristics of Malassezia folliculitis and use of the May-Grünwald-Giemsa stain to diagnose the infection.
Durdu M, Güran M, Ilkit M · Diagn Microbiol Infect Dis · 2013 · doi:10.1016/j.diagmicrobio.2013.04.011
Yeast-related folliculitis was found in 49 (18.5%) of 264 folliculitis patients in Adana; the study emphasized that it is often mistakenly treated with antibiotics for months.
- 2.Folliculitis.
Winters RD, Mitchell M · StatPearls [Internet] · 2023
A clinical reference summarizing the bacterial, fungal, viral and inflammatory types of folliculitis and approaches to diagnosis and treatment.
- 3.Facial bacterial infections: folliculitis.
Laureano AC, Schwartz RA, Cohen PJ · Clin Dermatol · 2014 · doi:10.1016/j.clindermatol.2014.02.009
Emphasized that staphylococcus is the most common bacterial cause of folliculitis and that folliculitis must be distinguished from pseudofolliculitis.
- 4.Malassezia (pityrosporum) folliculitis.
Rubenstein RM, Malerich SA · J Clin Aesthet Dermatol · 2014
Reported that yeast-related folliculitis is often confused with acne, is linked to flora-altering factors such as antibiotic use, and appears on the chest, back and face.
- 5.Evidence-based Danish guidelines for the treatment of Malassezia-related skin diseases.
Hald M, Arendrup MC, Svejgaard EL, Lindskov R, et al. · Acta Derm Venereol · 2015 · doi:10.2340/00015555-1825
Suggested that for yeast-related folliculitis, systemic antifungal treatment is probably more effective than topical treatment, and that a combination may be advantageous.
- 6.The Prevalence, Associated Factors, and Clinical Characterization of Malassezia folliculitis in Patients Clinically Diagnosed with Acne Vulgaris.
Paichitrojjana A, Chalermchai T · Clin Cosmet Investig Dermatol · 2022 · doi:10.2147/CCID.S395654
Yeast-related folliculitis was found in 28.8% of 320 patients diagnosed with acne; itching and placement on the upper back were important clues.
- 7.Pseudofolliculitis barbae; current treatment options.
Ogunbiyi A · Clin Cosmet Investig Dermatol · 2019 · doi:10.2147/CCID.S149250
Reported that shaving or plucking triggers an inflammatory reaction when sharp, growing hair tips pierce the skin, and that stopping shaving usually resolves the condition.
- 8.The human skin microbiome.
Byrd AL, Belkaid Y, Segre JA · Nat Rev Microbiol · 2018 · doi:10.1038/nrmicro.2017.157
Summarized that oily, moist and dry skin sites host different microbiome communities and that this balance is disrupted in skin diseases.
- 9.Topical Probiotics: More Than a Skin Deep.
Habeebuddin M, Karnati RK, Shiroorkar PN, et al. · Pharmaceutics · 2022 · doi:10.3390/pharmaceutics14030557
Reviewed how topical probiotics may show positive effects in inflammatory skin conditions such as acne, rosacea and psoriasis.
