Synopsis
Separate infectious folliculitis from ingrown-hair inflammation, recognise organism and exposure clues, sample selectively, modify hair-removal technique and reserve antimicrobials for a defensible infectious target.
- Folliculitis describes follicle-centred inflammation; determine whether the driver is bacterial infection, yeast, water exposure, occlusion, medicine, friction or an ingrowing hair before prescribing.
- Pseudofolliculitis is a sterile foreign-body reaction to a cut hair re-entering skin and is common with tightly curled or coarse hair, especially after close shaving, waxing or plucking.
- Visible or palpable ingrown hairs, papules aligned with the shaved area and post-inflammatory pigment change support pseudofolliculitis rather than bacterial infection.
Key red flags
Fever, hypotension, rapidly spreading cellulitis, disproportionate pain, perineal necrosis, orbital or central-facial extension, immunosuppression with progression, grouped vesicles near the eye or a fluctuant abscess requires urgent assessment.
Spreading warmth or colour change, rapidly increasing pain, fever, hypotension, fluctuance or necrosis signals cellulitis, abscess or deeper infection requiring urgent management.
Investigation priorities
Separate ingrowing-hair inflammation from infectious, water-associated, occlusive and medicine-related causes.
Management branches
Papules with ingrown hairs follow shaving, plucking or waxing without spreading infection.
- Explain the sterile foreign-body mechanism and, where feasible, stop close hair removal for four to six weeks while treating any confirmed superinfection separately.
- If removal must continue, use guarded electric clippers leaving short stubble, soften hair, shave with the grain without stretching skin, make one light pass and clean equipment.