After scratching at my lower legs intermittently throughout the day, I finally decided to take a look and see what was up. Both legs had what looked like bug bites. One was inflamed and warm to the touch. The skin was hard with the redness spreading to about four inches in diameter.
I used a Sharpie to outline the border of the inflamed area of skin. It had spread further the next morning, which suggested that these weren’t actually bug bites. The lack of fever suggested that it wasn’t cellulitis. However, the skin was infected. I thought Keflex would be a reasonable antibiotic choice and proceeded to self-medicate.
The Keflex did indeed work, but it wasn’t completely effective. So when I went into the clinic for a routine check-up, I asked the PA about it. She was not happy that I’d self-medicated (as anticipated) and prescribed clindamycin to clear up the infection. She also said it was folliculitis.
Though I understood exactly what she was saying, I hadn’t recalled hearing the term before, so I had to look it up at home. And while it isn’t covered in the standard off-grid medicine texts, the condition is addressed in The Ship’s Medicine Chest and Medical Aid at Sea. Here’s what it had to say:
Folliculitis is a superficial infection around the hair follicles usually caused by staphylococci strains of pus-forming bacteria. It is seen as redness around single or multiple hair follicles with progression to small red bumps within which pus develops. In addition to the face, especially the beard area, most often the extensor aspects of the body are involved, as the front of the legs and backs of arms.
Treatment
Treatment of folliculitis includes cleansing of the involved areas several times daily with a surgical detergent such as povidone-iodine. Skin irritants, as chemicals and oils, and friction from tightly fitting clothing should be avoided. Bacitracin ointment may be applied two or three times daily. However, as ointments are sometimes poorly tolerated, a drying lotion such as calamine lotion may be beneficial. Pricking the individual pustules with a sterile needle may hasten the clearing of lesions.
If the folliculitis is extensive or gives evidence of being resistant, treatment with a systemic antibiotic is indicated. Erythromycin 250 mg by mouth every six hours for ten days may be used.
The Ship’s Medicine Chest and Medical Aid at Sea, 1978, 238.
Like a good girl, I (almost) finished the course of clindamycin. However, within a few days, I had another infected hair follicle. This seemed ridiculous to me. To never have had folliculitis before, to suddenly have it appear on both legs, and then to have it happen again shortly after the first case resolved. I wouldn’t want to be dependent on conventional pharmaceuticals, especially if this is going to be a frequent occurrence. So I self-medicated again, but this time I only used an usnea tincture which I’d made 4-5 years ago and which I’d never yet had occasion to use on people.
It worked beautifully—better than the clindamycin, I’d say. And so while out camping for a family reunion this weekend, I made it a point to gather a lot more usnea. I’ll be tincturing it soon.
And while folliculitis isn’t covered in the off-grid texts, substantially more information is available online to help us determine whether an infection is folliculitis, risk factors, and how to avoid and treat it.
Identification
Folliculitis most often appears as red, inflamed bumps and may even develop white heads like acne. It may occur anywhere that hair grows on the body but is most common in the following areas:
- Scalp
- Legs
- Arms
- Buttocks
- Armpits
Types of folliculitis
- Viral—this uncommon form appears as bumps close to herpes simplex cold sores and is also spread by shaving.
- If caused by herpes simplex, the sores may be tender and usually resolve within 10 days. Severe, recurring episodes may be treated with acyclovir or other antivirals.[1]
- Herpes zoster (shingles) may present as folliculitis with painful pustules and crusted areas. Physicians often prescribe high dose acyclovir.[2]
- Molluscum contagiosum is common in young children and presents with follicular umbilicated papules clustered in and around a body fold.[3]
- Drug-induced folliculitis may be caused by certain medications like isoniazid, steroids, lithium, and some seizure medications.[4]
- Staphylococcal folliculitis occurs as a result of bacteria that are naturally present on the body or from another person.[5]
- Fungal folliculitis most often affects the face and upper body. It is treated with topical and oral antifungal drugs. [6]
- Hot tub folliculitis normally appears a few days after the patient used a hot tub and in most cases will resolve in a few days without any medical intervention.[7]
Risk factors
Folliculitis is somewhat contagious. It spreads more easily on a person from one body part to another. Scratching the bumps on one body part and then scratching another body part spreads the bacteria well. While person-to-person spread is less common, it is still possible and most often occurs in these situations:
- Folliculitis caused by the herpes simplex virus—it is spread by bodily fluids.
- Folliculitis caused by staph infections, especially from cuts or open wounds, or from shaving.
- Hot tub use.
Treatment
Physicians may prescribe or recommend any of the following:
· Wear loose, dry clothing. [18]
· Stop the activity that is causing the infection, i.e., quit wearing tight clothing, quit shaving, don’t use the hot tub. [19]
· Apply a warm compress several times per day. [20] [21]
o Boil 2-3 cups of water and let it cool to room temperature.
o Stir in 1 teaspoon table salt.
o Soak the compress in the salt solution and then wring out water.
o Apply gently to affected skin.
o Repeat several times per day using a clean washcloth.[22]
· Apply Hibiclens, benzoyl peroxide (5% for 5-7 days when showering[23]), or an antifungal cream. [24]
· Bathe in lukewarm water (hot water will further irritate and inflame folliculitis). [25]
· Silver sulfadiazine or white vinegar applied for 20 minutes 2-4 times per day.[26]
· Cephalexin, 250-500 mg, 3-4 times per day for 10 days.[27]
· Pure aloe vera gel without any added chemicals or scent.[28]
· Apply hydrogen peroxide to the skin several times per day.[29]
· Apply an antibiotic cream only to the affected area.[30]
· Apply hydrocortisone to reduce itching.[31]
· Apply a wet wrap:
o Wash hands and the affected area with soap.
o Pour boiled water into a clean bowl.
o Dip gauze in the water, wring, and lay over affected area, repeating until entire area of folliculitis is covered.
o Cover the wet bandages with dry ones.
o Leave on for up to 8 hours.
o Remove bandages and repeat process with clean bandages if desired.[32]
· Essential oils diluted in a carrier oil may help treat folliculitis:
o Chamomile
o Cinnamon
o Clove
o Eucalyptus
o Lemon
o Tea tree[33]
Links to related posts:
Ship’s Medicine Chest and Medical Aid at Sea—Book Review
Dealing with
Cellulitis in Doomsday
[1] https://dermnetnz.org/topics/folliculitis
[2] https://dermnetnz.org/topics/folliculitis
[3] https://dermnetnz.org/topics/folliculitis
[4] https://dermnetnz.org/topics/folliculitis
[5] https://my.clevelandclinic.org/health/diseases/17692-folliculitis
[6] https://my.clevelandclinic.org/health/diseases/17692-folliculitis
[7] https://my.clevelandclinic.org/health/diseases/17692-folliculitis
[8] https://my.clevelandclinic.org/health/diseases/17692-folliculitis
[9] https://my.clevelandclinic.org/health/diseases/17692-folliculitis
[10] https://my.clevelandclinic.org/health/diseases/17692-folliculitis
[11] https://my.clevelandclinic.org/health/diseases/17692-folliculitis
[12] https://www.healthline.com/health/folliculitis#what-it-is
[13] https://my.clevelandclinic.org/health/diseases/17692-folliculitis
[14] https://www.healthline.com/health/folliculitis#what-it-is
[15] https://www.healthline.com/health/folliculitis#what-it-is
[16] https://www.healthline.com/health/folliculitis#what-it-is
[17] https://www.healthline.com/health/skin/folliculitis-home-treatment#when-to-see-a-doctor
[18] https://www.healthline.com/health/skin/folliculitis-home-treatment#when-to-see-a-doctor
[19] https://my.clevelandclinic.org/health/diseases/17692-folliculitis
[20] https://my.clevelandclinic.org/health/diseases/17692-folliculitis
[21] https://www.mayoclinic.org/diseases-conditions/folliculitis/diagnosis-treatment/drc-20361662
[22] https://www.healthline.com/health/skin/folliculitis-home-treatment#when-to-see-a-doctor
[23] https://www.merckmanuals.com/professional/dermatologic-disorders/bacterial-skin-infections/folliculitis
[24] https://my.clevelandclinic.org/health/diseases/17692-folliculitis
[25] https://my.clevelandclinic.org/health/diseases/17692-folliculitis
[26] https://www.healthline.com/health/folliculitis#what-it-is
[27] https://www.merckmanuals.com/professional/dermatologic-disorders/bacterial-skin-infections/folliculitis
[28] https://www.healthline.com/health/skin/folliculitis-home-treatment#when-to-see-a-doctor
[29] https://www.healthline.com/health/skin/folliculitis-home-treatment#when-to-see-a-doctor
[30] https://www.healthline.com/health/skin/folliculitis-home-treatment#when-to-see-a-doctor
[31] https://www.healthline.com/health/skin/folliculitis-home-treatment#when-to-see-a-doctor
[32][32] https://www.healthline.com/health/skin/folliculitis-home-treatment#when-to-see-a-doctor
[33] https://www.healthline.com/health/skin/folliculitis-home-treatment#when-to-see-a-doctor
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