Folliculitis vs. Acne: What’s the Difference?

One day your skin is clear — and the next you notice bumps on your body that look like little pimples.

Must be time to apply an acne treatment, right? Not so fast.

While they might present in a similar fashion, acne and folliculitis are two different skin conditions that need to be cared for in different ways. 

Acne is caused by blocked pores, while folliculitis is caused by inflamed hair follicles.

Read on to learn more about the differences between folliculitis and acne, and how to treat each condition.

What Is Acne?

Acne (specifically acne vulgaris) is a skin condition that occurs when the pores of your skin become blocked by hair, sebum (an oily substance produced by your skin), bacteria and dead skin cells. It is typically found on the face, forehead, chest (chest acne), shoulders and upper back.

The root causes of acne can vary widely and include genetics, fluctuating hormone levels, stress, high humidity and using oily or greasy personal care products. 

Types of Acne

One reason it’s easy to confuse acne with folliculitis is that acne comes in several forms. The different types of acne include:

• Blackheads: These occur when a pore fills with excess oil and dead skin, and remains open. While the open space may look as though dirt has been deposited in the bump, the apparent color is actually caused by an irregular light reflection off the clogged follicle.

• Whiteheads: These happen when a pore becomes clogged by oil and dead skin, but remains closed. It may look as though a white substance is poking out of the skin.

• Papules: These small bumps can be red or pink and are often inflamed.

• Pustules: Pimples can sometimes contain pus and these resemble whiteheads ringed by red.

• Nodules: These solid pimples are deep in your skin, and can be large and painful.

• Cysts: These pus- and oil-filled pimples can vary in size and are typically inflamed.

What Is Folliculitis?

Folliculitis is also a common skin condition, but instead of being caused by blocked pores, it occurs when a damaged hair follicle becomes infected or inflamed. 

It can appear anywhere on the body except for the lips, palms and soles of your feet, and usually looks like a sudden acne breakout. 

If you notice a red ring around each bump, too, it is a sign of infection.

Follicle damage can happen from a number of causes including:

• Frequent skin irritation such as rubbing

• Too-tight clothing which can cause chafing

• Shaving too close with a razor

• Sitting in a whirlpool tub 

Once a follicle is damaged, it’s easier for bacteria to invade it, causing bacterial infections and inflammation. 

A type of bacteria named Staph aureus is a common source of infection, but there are other organisms that live on our skin, which can also contribute to infection.

It’s important to note that follicle damage doesn’t cause folliculitis in and of itself; the bacteria also needs to enter the follicle. 

The most common opportunities for this are similar to those that cause follicle damage, noted above, and include:

• Bathing in an improperly maintained hot tub (folliculitis tends to especially occur where skin was covered by a bathing suit)

• Waxing, tweezing or shaving the skin

• Certain medications such as coal tar that aren’t breathable

• Taking an oral antibiotic for an extended period of time

• Not rinsing off after activities that cause you to sweat 

Folliculitis symptoms include spots as noted above, and red, itchy or painful skin. Sometimes, too, folliculitis presents with no symptoms at all.

Types of Folliculitis

Similar to acne, there are many types of folliculitis, mostly classified by what caused the folliculitis, and where on the body it can be found.

• Staphylococcus aureus folliculitis: One the most common forms of folliculitis, it’s caused by the bacteria Staphylococcus aureus. It looks like small red or white pus-filled pimples, and usually resolves on its own. Severe or persistent cases will need to be treated by a healthcare provider.

• Pseudomonas aeruginosa folliculitis: Commonly known as ‘hot tub folliculitis,’ these bumps are caused by Pseudomonas aeruginosa, a bacteria that thrives in warm, moving water. A breakout of this type looks much like the rash caused by Staphylococcus aureus, but can sometimes be itchy. It will occur one to two days after exposure and typically fade on its own within a few days and rarely requires medical attention.

• Malassezia folliculitis: This type of folliculitis is caused by a family of yeast known as malassezia that can commonly be found on the skin. It causes an itchy condition that looks like an acne breakout, is usually found on the upper chest and back, and can be further aggravated by sweat. Anti-dandruff shampoo can sometimes be helpful for clearing this condition.

• Pseudofolliculitis barbae: This type of folliculitis is what you see when you get razor bumps, and it usually occurs in the beard area for guys (or your bikini area). Cutting these hairs with a razor creates a sharp edge at the end of the hair, which can then turn back into the skin and cause irritation. This version of folliculitis is more common in people with curly hair, and is especially prevalent in Black men. If you get razor bumps, it’s helpful to avoid shaving or using a trimmer until you’ve allowed hair to grow out for three to four weeks, and a healthcare provider can be consulted for more persistent cases.

• Sycosis barbae: This is a particularly severe form of folliculitis also caused by shaving, and results in the entire hair follicle being infected — displaying as large, red pustules. This condition can result in severe scarring, and to manage it, it’s important to stop shaving. You’ll also want to consult a healthcare provider for advice or treatment.

• Gram-negative folliculitis: These bumps sometimes occur if you’ve been using antibiotics to treat acne over a prolonged time. Over time, resistant bacteria will grow and multiply, sometimes leading to the worsening of the acne that is being treated. Talk to your healthcare provider if you experience this condition.

• Boils: Also known as ‘furuncles,’ these painful bumps happen when a hair follicle becomes deeply infected, leaving the area red, tender and painful. The boil will eventually burst after several days, often leaving a scar. Some cases require medications or a procedure for treatment.

• Carbuncles: These are the result of several boils developing in one spot, and they’re usually indicative of multiple infected hair follicles. Treatment is similar to that of boils, requiring attention from a healthcare provider.

• Eosinophilic folliculitis: This type of folliculitis is usually seen in people who are immunosuppressed, and a similar form can also be found in babies. It is characterized by itchy pustules which tend to most often appear on the shoulders, upper arms, neck and forehead. They usually self-resolve, but can be recurring.

Apart from the types of folliculitis you’ll need to have treated by a healthcare professional, most breakouts go away on their own if you have a strong immune system. You’ll also need to stop doing the activity that triggered the folliculitis in the first place.

To quicken the healing process and get some relief from any discomfort, you can apply warm compresses to the area. Make sure your compress is clean, and apply it three to four times a day for fifteen to twenty minutes each time.

If your folliculitis isn’t clearing, consult your healthcare provider. They will be able to treat your folliculitis and give you tips for avoiding it in the future.

Acne vs. Folliculitis: How to Know for Sure

Now that you have the hallmarks of acne and folliculitis down, you should have enough information to differentiate between the two, right?

Not exactly. Due to the similarities between acne vulgaris and folliculitis, the two can sometimes be hard to differentiate and easy to misdiagnose. 

If you experience red bumps that won’t go away, or which just don’t seem like acne, consult with a healthcare provider to obtain a diagnosis of folliculitis or acne — and get the care you need that’s best for you.