Folliculitis after laser hair removal and shaving

Every hair has a follicle, a pocket in the skin it grows from. When bacteria get into the follicle, most often Staphylococcus aureus from the skin surface, inflammation forms around the hair. As Cleveland Clinic and the American Academy of Dermatology describe it, these are small red bumps or pustules with a white head, one around each hair, and the skin around them itches or is a little sore. The rash sits where hair is shaved or where skin rubs and sweats: legs, thighs, buttocks, bikini area, underarms.

Folliculitis is easy to confuse with razor burn and with ingrown hairs. Razor burn: redness and small bumps without pus, appearing right after shaving and gone in a day or two. Ingrown hairs: a firm bump with a curled hair visible under the skin, most often in the bikini area. Folliculitis differs by the pus-filled head and by timing: the bumps appear one to three days after shaving or a session, not immediately.

Sources: Cleveland Clinic, folliculitis, American Academy of Dermatology, folliculitis

The laser heats the follicle, and for the first few days after a session the skin around the hairs is slightly inflamed and more vulnerable than usual. If the follicle gets blocked by sweat, cream or tight clothing during that time, bacteria get in easily. The typical scenario: a session on the legs, then the gym in leggings or a sauna, and two days later pustules. The second route: a scrub or a washcloth on fresh skin. In our practice it is rare and almost always on the legs, the largest area, where the skin stays under clothing the longest.

Do not confuse it with the normal reaction to a session: redness and "goosebumps" around the hairs in the first hours after laser, without pus, is the follicles' normal response to heat and goes away by the evening or the next day. Other reactions are covered in laser hair removal side effects and risks.

Sources: Cleveland Clinic, laser hair removal

A razor leaves micro-scratches and opens the mouth of the follicle; wax and epilators pull the hair out and injure the whole follicle. If the razor is old, the skin is dry and tight clothes go on right after shaving, bacteria get inside. According to the American Academy of Dermatology, shaving, plucking and waxing are among the main causes of folliculitis, together with poorly maintained hot tubs and tight clothing. In people with coarse, curly hair shaving also causes pseudofolliculitis: the hair curls back into the skin and inflammation forms around it. How to shave without that is covered in razor burn and bumps.

Mild folliculitis, a few pustules without pain or fever, is treated with care, not medication. What dermatologists advise and what we advise:

• Hands off: do not squeeze, rub or scrub. Every squeeze spreads bacteria to the neighbouring follicles.
• Warm compress: a clean towel soaked in warm water for 15-20 minutes three to four times a day, as the American Academy of Dermatology advises. The pustules open and heal faster.
• Wash the area with a mild antibacterial wash or just soap and water, pat dry, do not rub, and use your own clean towel.
• A thin layer of panthenol after washing. No rich creams, oils or heavy lotions: they block the follicles.
• Loose cotton clothing, no synthetics or leggings, until it clears.
• No sauna, pool, hot bath or gym until healed: sweat and heat feed the inflammation.
• Do not shave the area until the pustules are gone, usually a week to ten days. Then only with a new razor.

Sources: American Academy of Dermatology, folliculitis

Hormonal ointments, that is corticosteroid creams, are not used on folliculitis without a doctor's prescription. They relieve itching but do nothing to the bacteria, and according to the Merck Manual a topical antibiotic (mupirocin, clindamycin) prescribed by a doctor is usually enough for bacterial folliculitis. A steroid cream can mask an infection, and the Merck Manual lists prolonged corticosteroid use among the risk factors for fungal folliculitis. If a dermatologist prescribes such a cream for a non-purulent, allergic inflammation, that is their decision after an examination, not self-treatment on internet advice.

Sources: Merck Manual, folliculitis

A doctor will confirm the diagnosis, prescribe an antibiotic cream or tablets for a bacterial cause and an antifungal for a fungal one. Do not "prescribe" yourself an antibiotic from the pharmacy: without an examination folliculitis is easily confused with a fungal or sterile inflammation, where an antibiotic will not help. See a doctor if:

• The pustules do not shrink after a week of home care, or spread to new areas.
• Large painful lumps or boils appear, or the skin around is hot and firm.
• You have a fever or swollen lymph nodes.
• The folliculitis comes back after every shave, month after month.

No. Laser is not applied to inflamed skin: the heat intensifies the inflammation, and a pustule under the handpiece leaves a mark and a risk of scarring. We do not take anyone with active folliculitis for a first session, and if it appears between sessions we postpone the next visit until the skin is clear. The course does not suffer: a delay of a week or two does not spoil the result, laser on inflamed skin can. The same applies to folliculitis from shaving before a first session: treat it first, then laser.

Before the session: shave the body the day before with a new razor, clean skin, no creams or deodorant. After the session: the first 1-2 days without sauna, pool, hot bath or hard exercise, loose clothing, do not rub or scrub the area, panthenol only. Details in skin care after laser hair removal. The less hair is left after the course, the rarer folliculitis is at all, because there is no shaving and no follicles with hair for bacteria to get into. For anyone who gets pustules after every shave, a laser course removes the cause itself: shaving.

Folliculitis after laser is rare among our clients, mostly on the legs, and clears within two weeks. If it appears, we postpone the next session and ask for one thing: treat the inflamed skin as gently as possible. Panthenol, no sauna, pool, creams or scrubs, loose clothing. With active folliculitis, from shaving or anything else, we do not treat; the skin has to heal first. At every visit the specialist examines the area before the first pulse, and if they see inflammation they skip the spot or postpone the visit.