Do you have acne, or is it an imposter? How can you tell? Acne is a common skin condition that affects millions of people worldwide. However, there are several conditions that can mimic acne, making it difficult to differentiate between them. In this blog, I’ll walk you through some of the most common acne imposters: folliculitis, keratosis pilaris (KP), and perioral dermatitis.
I’ll outline key identifiers for these conditions along with product solutions that can help clear your skin. Although these “imposters” can look similar to acne, they are quite different and don’t respond to traditional acne treatments.
Folliculitis
Folliculitis is a common acne imposter that occurs when hair follicles become infected with bacteria or fungi. It can look similar to acne, but instead of blackheads and whiteheads (comedones), it typically presents as small, red bumps that may be itchy or painful. Folliculitis can occur anywhere on the body where there are hair follicles, but it is most commonly found on the scalp, forehead, jawline, neck, chest, and back.
Common Types of Follicultis:
Bacterial Folliculitis
Bacterial folliculitis is the most common type of folliculitis. It is characterized by a rash of itchy, pus-filled bumps that occurs when hair follicles become infected with bacteria, usually Staphylococcus aureus (staph). Staph bacteria are always present on the skin, but cause issues when they find entry into the body.
Home Care
- Avoid overly emollient or creamy moisturizers, sunscreens, and oils.
- Keep the affected areas as dry as possible.
- Use GlyMed Plus Blemish Control No. 5 (with benzoyl peroxide) to reduce acne and staph bacteria.
- Once cleared, maintain results and prevent recurrence with Hale & Hush Clarify Wash.
Pseudofolliculitis Barbae (PFB) - (shaving bumps)
Also extremely common, this form of folliculitis comes from ingrown hairs. It occurs when the hair follicle is damaged by friction, shaving, waxing, or tweezing, and is most common in people with curly or coarse hair. When hair tries to grow back, it causes rash, itching, pimples, and pustules that may crust over. PFB most commonly afects those who regularly shave their face but can also happen when shaving the legs or bikini area.
Home Care
- Avoid overly emollient or creamy moisturizers, sunscreens, and oils.
- Keep the affected areas as dry as possible.
- Use a clean washcloth or towel every time you cleanse your skin.
- Shave less often.
- Use Colore Science Barrier Pro 1-Step Cleanser to repair the microbiome.
- Use an AOS Blue Face Scrubbie in a gentle circular motion to raise embedded hairs before shaving.
- Tone the skin with Rhonda Allison Mandelic Purfying tonic to prevent ingrown hairs and provide anti-fungal support.
- Shave in the direction of hair growth.
- Use a clean, sharp single-edge blade and rinse with warm water after each stroke.
- Avoid shaving the same area more than twice.
Avoid shaving for at least four weeks to allow the skin to heal. If shaving is necessary, use an electric shaver or single-edged razor to minimize irritation.
Malassezia (Pityrosporum) Folliculitis - (also known as fungal acne)
This form of folliculitis is an inflammation of the hair follicle caused by a fungal infection or yeast. Malassezia yeast is always present, but causes issues when there is an overgrowth on the skin. Malassezia folliculitis can appear as small papules or pustules on the skin, often on the chest, back, and upper arms. It can result from extended use of antibiotics or steroids, oily skin, humidity, occlusive clothing, and heavy moisturizers. The condition can be itchy and uncomfortable, and may persist for several months or longer if left untreated.
Home Care
- Avoid overly emollient or creamy moisturizers, sunscreens, and oils.
- Keep the affected areas as dry as possible.
- Avoid wearing constrictive clothing or clothing that doesn't allow the skin to breathe.
- Managing fungal folliculitis involves topical or oral antifungal medications and maintaining good skin hygiene to limit yeast growth.
- For daily care, Hale & Hush Clarify Wash offers effective antifungal support and can be used on the entire body.
- A beneficial topical is Face Reality Sulfur Spot Treatment, which can be used over the entire problem area.
Pseudomonas Folliculitis - (also known as Hot Tub rash)
Pseudomonas folliculitis, or “hot tub” folliculitis, typically occurs after exposure to contaminated bodies of water such as swimming pools, hot tubs, water slides and sometimes even freshwater sources. The pseudomonas bacteria thrives in heated, moving water where chlorine and pH levels are imbalanced. Symptoms of this infection include itchy, red bumps that may be filled with pus and appear within hours to days after exposure.
Home Care
Pseudomonas folliculitis is usually not a serious infection and can clear up on its own within a week, but in some cases, antibiotics may be necessary to treat the infection. To prevent it, avoid using contaminated water sources and properly clean and maintain swimming pools and hot tubs.
Gram-negative Folliculitis
This is another form of bacterial infection that causes red or pus-filled bumps around the mouth and nose area. It often develops in people receiving long-term antibiotic therapy for acne, such as tetracycline or other topicals. The prolonged use of antibiotics leads to the development of antibiotic-resistant bacteria that are difficult to eradicate.
Treatment
Treatment often requires a combination of oral antibiotics, topical prescriptions, and professional guidance. Over-the-counter products are generally not effective, so consulting a dermatologist is essential for proper management.
Keratosis Pilaris (KP)
Keratosis pilaris (KP) is a common acne imposter affecting millions worldwide. It appears as small, non-inflamed, red or skin-colored bumps that resemble acne and typically develop on the upper arms, thighs, and buttocks. It is often referred to as "chicken skin." KP occurs when keratin, a protein found in the skin, builds up and plugs hair follicles. The condition is most common in children and adolescents, but can also affect adults. It can worsen in dry winter weather. Although harmless, KP can be very frustrating to treat.
Home Care
While there’s no cure for KP, consistent exfoliation and hydration can greatly improve skin texture.
Exfoliate: Start with GlyMed Plus Refining Body Scrub with AHAs to gently slough away buildup.
Moisturize: Follow with BiON Glycolic 20% Skin Cream to soften and smooth rough, bumpy skin.
With regular use, these steps can help reveal clearer, more even-toned skin.
Perioral Dermatitis
This acne Imposter, perioral dermatitis, is a common skin condition that presents as patches of itchy, red, or tender spots around the mouth, nose, and chin and can even spread up to the eye area. It often looks like small, red, acne-like breakouts and appears dry and flaky. The cause of perioral dermatitis is not fully understood, but it is believed to be related to a disruption of the skin barrier, an overgrowth of bacteria, or a reaction to topical products. Symptoms can be worsened by certain triggers such as harsh cleansers, steroid creams, or oral contraceptives.
Home Care
- Avoid overly emollient or creamy moisturizers, sunscreens, and oils.
- Keep the affected areas as dry as possible.
- Avoid acidic and spicy foods.
- Avoid toothpastes that contain fluoride or Sodium Lauryl Sulfate.
- Use Colore Science Barrier Pro 1-Step Cleanser to repair the microbiome.
- Treat the affected area with Face Reality Sulfur Spot Treatment.
- ColoreScience Barrier Pro Essential Moisturizer is lightweight and will help balance the microbiome while strengthening the skin barrier.
ANTIFUNGAL SUPPLEMENTS
*If you suspect you have a fungal infection, here is a list of supplements to look for. Select one or two and rotate every few weeks:
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- Probiotic supplements—These are good if you have been on antibiotics for a long time. There is no need to rotate them as often as other supplements. We recommend Terraflora Advanced Care Synbiotic Probiotic for rebalancing and Terraflora Daily Care Synbiotic Probiotic for maintenance.
- Caprylic Acid supplement
- Undecylenic Acid supplement
- Grapefruit Seed Extract
- Olive Leaf Extract
- Neem Oil (topical use only)
- Oil of Oregano
- Apple Cider Vinegar (tablets or liquid)
- Garlic
- Pau D’Arco
- Berberine
- Grape Seed Oil
In conclusion, not all skin conditions that look like acne are actually acne. Folliculitis, keratosis pilaris, and perioral dermatitis are three common acne imposters that can be difficult to differentiate from acne. If you’re unsure about which type you have or how to treat it, reach out to us at AOS. Whether it’s our live chat or an Acne Consult with our certified acne specialist, our knowledgeable team of estheticians is here to answer your questions.
