Treating Folliculitis

Folliculitis is an infection of the hair follicles, most often caused by staphylococcus bacteria, although more rarely it can be caused by fungus or a mite called demodex¹.

Differential diagnosis can be achieved via dermoscopy² (looking at the skin with a magnifying glass/microscope), although to differentiate between different types of bacteria/pathogen you might need to take a biopsy (piece of skin is removed, this is the extreme option).

The preferred treatment is topical antiseptics. A course of systemic oral antibiotics may be viable but should only be used as a last resort since it’ll kill off your gut microbiome and is likely to have unpleasant side effects and weaken your immune system³. There are also some topical antibiotics such as clindamycin and gentamicin available.

---

How I treated my folliculitis

I struggled with it for about a year, it was a huge source of dysphoria and extremely resilient, saw a dermatologist and was told "you'll probably have it for life, there’s not much I can do" at which point my innate hate for the medical establishment kicked into full gear and i became rather obsessed with treating it. If you want a job done properly you have to do it yourself.

I performed dermoscopy using a 10x handheld loupe and subsequently at ~40x using a stereo microscope. I suspected I had folliculitis due to some strain of bacteria. Just in case, I used permethrin (an anti-parasite medication) over the course of a few days, although (as expected) this did not help. I also tried using ketoconazole (brand name Nizoral), an antifungal, and this did not help either.

I proceeded to use chlorhexidine wash daily in my showers (pictured, Hibiscrub), as well as leaving benzoyl peroxide cream on my entire lower body overnight, using exfoliant a few times a week. there are other OTC antiseptics available, including zinc oxide, cetrimide, octenidine, among others.

I changed all my clothes daily and bedsheets twice a week.

Continuing this over the course of a few weeks, I had completely gotten rid of my folliculitis. It took a lot of effort but well worth it. And don’t take the word of doctors as gospel!

1. Folliculitis and Other Follicular Disorders | Plastic Surgery Key. https://plasticsurgerykey.com/folliculitis-and-other-follicular-disorders/ (accessed 2023-01-01).

2. Durdu, M.; Errichetti, E.; Eskiocak, A. H.; Ilkit, M. High Accuracy of Recognition of Common Forms of Folliculitis by Dermoscopy: An Observational Study. J. Am. Acad. Dermatol. 2019, 81 (2), 463–471. https://doi.org/10.1016/j.jaad.2019.03.054.

3. Lin, H.; Lin, P.; Tsai, Y.; Wang, S.; Chi, C. Interventions for Bacterial Folliculitis and Boils (Furuncles and Carbuncles). Cochrane Database Syst. Rev. 2018, 2018 (8), CD013099. https://doi.org/10.1002/14651858.CD013099.