Acne & Folliculitis Breakout Treatment in London

Acne vs Folliculitis: What’s the Difference between Acne & Folliculitis?

“Breakouts” is an umbrella term people use for spots, bumps and pustules. Two of the most common causes are acne and folliculitis. Although they can look alike at first glance, the processes underneath are different. Acne arises when pores (pilosebaceous units) become blocked with oil and dead skin, then inflame due to local bacteria and the skin’s immune response. Folliculitis, by contrast, is inflammation of the hair follicle itself, often triggered by friction, shaving, sweat, tight clothing, or overgrowth of bacteria or yeast. Because the causes differ, the most effective treatments differ too. A careful assessment saves time, cost and frustration.

How to Spot the Clues

• Comedones (blackheads/whiteheads) → think acne. These are blocked pores and usually do not occur in folliculitis — see comedonal acne.
• Itchy, pin-point pustules around individual hairs → think folliculitis. They may appear in crops after shaving, waxing or heavy sweating.
• Deep, painful nodules and cysts → severe acne. These can scar without early care; read about acne scarring.
• “Razor bumps”/ingrowns on beard, bikini line or thighs → pseudofolliculitis. Curly hairs are prone to re-entering the skin — laser hair removal may help reduce ingrowns.
• Uniform tiny bumps on chest, back or forehead, worse with sweat → “fungal acne”. This is Malassezia (yeast) folliculitis — see Malassezia folliculitis — and needs antifungal care rather than antibiotics.

Why Breakouts Happen: Common Triggers

Acne is largely driven by hormones, genetics and how sticky the pore lining becomes. Stress, high-glycaemic diets and certain cosmetic products can aggravate it. Folliculitis flares with friction, occlusive clothing, hot tubs, synthetic sportswear, heavy oils on hair or skin, and shaving methods that cut hairs below the skin surface. Antibiotics used repeatedly for acne can unbalance the skin microbiome and, paradoxically, set the scene for yeast overgrowth and folliculitis.

Types of Acne & Folliculitis We See

Acne vulgaris

Ranges from comedonal (blackheads/whiteheads) to inflammatory papules and pustules, through to nodulocystic acne. Face, chest and back are typical sites. Darker skin tones often show more post-inflammatory hyperpigmentation (PIH) after inflammation settles — see hyperpigmentation treatment.

Hormonal pattern acne

Often worse pre-menstrually, with deeper lesions on the jawline, chin and neck. A thoughtful plan may include topical retinoids and, where appropriate, hormonal approaches prescribed by your clinician — explore our acne treatment options.

Bacterial folliculitis

Usually due to Staphylococcus aureus overgrowth in hair follicles; presents as crops of pustules on any hair-bearing site. Targeted antiseptic care and, when indicated, short courses of anti-bacterial therapy help. For diagnosis, we may use a skin swab test.

“Fungal acne” (Malassezia folliculitis)

Monomorphic, itchy bumps on the trunk, shoulders or forehead that worsen with sweat and antibiotics. This is not acne and responds to antifungals and lifestyle tweaks that reduce occlusion — confirmed with fungal testing if needed.

Pseudofolliculitis barbae (razor bumps)

Inflammation from ingrown hairs after shaving or waxing, most common in curly/coiled hair. Adjusting technique and hair length, plus gentle keratolytics, reduces flare-ups; longer-term reduction is possible with laser hair removal.

Diagnosis at Skinhorizon

Your clinician will take a careful history (onset, triggers, shaving habits, sports, skincare and medicines) and examine the pattern and distribution of lesions. Where needed, we may use dermoscopy or take a targeted swab/fungal test to clarify bacterial vs yeast overgrowth. Identifying the dominant process (acne vs folliculitis) lets us create a plan that works with your skin rather than against it.

Treatment Pathways

Successful treatment balances fast relief with long-term prevention. We build a plan from these pillars:

1) Daily Skincare Foundations

• Cleanse: gentle, non-foaming or lightly foaming cleanser twice daily; cleanse after sport.
• Target: benzoyl peroxide, retinoids, azelaic acid — see our medical acne & folliculitis treatment pathways.
• Moisturise: non-comedogenic hydrators keep the barrier healthy and reduce rebound oiliness.
• Protect: daily broad-spectrum SPF to limit PIH (especially important in skin of colour) — more on PIH management.

2) Focused Acne Treatments

• Topical retinoids: cornerstone for comedones and prevention; introduced gradually to minimise dryness.
• BPO combinations: reduce bacterial load and resistance when antibiotics are used.
• Short antibiotic courses: used selectively for inflammatory flares, always paired with BPO.
• Hormonal options: considered where pattern suggests hormonal drive (discussed case-by-case).
• Intralesional injections: tiny steroid injections flatten painful nodules quickly and reduce scarring risk.
• Isotretinoin: for severe, scarring or relapsing acne when other options are insufficient; requires structured monitoring and pregnancy prevention where relevant.

3) Folliculitis-Specific Care

• Antiseptic washes and simple routines that reduce occlusion and friction.
• Targeted antibiotics for confirmed bacterial folliculitis, used briefly to settle flares.
• Antifungals (topical or oral) for Malassezia folliculitis; avoiding unnecessary antibiotics is key.
• Shaving adjustments (see below) and hair-care tweaks to limit ingrowns and razor bumps.

4) Procedures That Help

• Comedone extraction for stubborn blackheads/whiteheads.
• Superficial peels to smooth texture and reduce PIH once inflammation is controlled — consider carbon laser peel or LED phototherapy where suitable.
• Intralesional therapy for rapid relief of nodules.

5) Antibiotic Stewardship

Antibiotics are not a cure for acne and can worsen yeast folliculitis if overused. When we do prescribe them, we keep courses short, combine with BPO, and switch to maintenance strategies promptly.

6) Special Situations

• Pregnancy: many effective options remain, but some medicines (e.g., retinoids) are avoided — your plan is adjusted safely.
• Skin of colour: we emphasise PIH prevention, gentle strengths and sun protection to minimise marks — see hyperpigmentation care.
• Athletes/occupational heat: sweat-management strategies and fabric choices reduce friction and flare-ups.

Shaving & Ingrown Hair Tips

• Shave in the direction of growth; avoid pulling the skin taut.
• Use fewer blades or an electric trimmer to leave a small hair length rather than a sub-surface cut.
• Soften hairs first (warm water, gentle cleanser), and use a non-occlusive shave product.
• Post-shave, apply a bland moisturiser; introduce mild keratolytics (e.g., urea or salicylic) gradually if tolerated.
• Limit tight collars/helmets against freshly shaved skin; cleanse after sport. Consider laser hair removal for recurrent ingrowns.

Scarring & Post-Inflammatory Marks

Even when breakouts settle, discolouration can linger. We pace pigment-safe treatments (e.g., azelaic acid, retinoids, measured peels) once active inflammation is controlled. For textural change, options include acne scar treatments such as microneedling and fractional CO₂ laser.

Prevention & Everyday Habits

• Stick to a simple routine you can keep going; small daily steps beat occasional intensity.
• Shower and cleanse after training; change out of sweaty kit promptly.
• Choose non-comedogenic, fragrance-minimal products.
• Manage stress and aim for regular sleep; both skin and habits benefit.
• Some people notice flares with high-glycaemic foods or skim milk; a balanced, lower-GI pattern may help.

Results & Timeline

Most topical programmes need 6–12 weeks for steady visible change; nodules treated with injections improve within days. Correctly managed folliculitis often settles within 1–2 weeks. We agree milestones so you know what to expect and when to review.

Why Choose Skinhorizon?

We provide consultant-led dermatology in a CQC-regulated clinic, combining medical expertise with clear, practical plans. Our approach is precise diagnosis, targeted therapy, and prevention-focused maintenance, so improvements last and confidence returns.

Your First Visit — What to Expect

1. History and skin examination to differentiate acne from folliculitis and map triggers.
2. Discussion of treatment options tailored to your goals, skin type and schedule.
3. A clear, stepwise programme with expected timelines and aftercare — see our treatment pathway.
4. Follow-up plan to review progress, adjust strengths and prevent relapse.