Q: I’m a 40-year-old man and recently got my first wax on my chest and my back. My chest was fine but my back has broken out in a rash that doesn’t seem to be clearing. It’s a bumpy rash, and a lot of the spots are quite red. I got the wax six weeks ago and was hoping it would clear up, but it hasn’t. I have tried a few different things like aloe vera, a tea tree anti-bacterial cream and I’ve also been exfoliating, but nothing seems to be working. I read online that ingrown hairs might be an issue. I’m wondering if it’s something that needs to be checked out?
Dr Grant replies: I suspect you’ve broken out in your first ever attack of folliculitis, which is fairly common after shaving or waxing when the hair follicle may suffer minor damage. The term folliculitis means inflammation around the hair follicles, the tiny holes that each individual hair grows from. Initially, it often looks like small red bumps — inflamed papules, typically 2 to 5mm in size, with a hair piercing the central aspect — with or without pustules (well-circumscribed collections of white blood cells and serous fluid). Itch is the most common symptom and pain may occur, typically if pustules are present.
Mild cases often self-resolve over a few weeks. An attack can occur on any part of the face or body that has hair. There are a few different types of folliculitis depending on the cause, whether infectious or non-infectious, and if it involves the superficial or deep layers of skin where large nodules (large palpable lesions >1cm that are usually dome shaped) can form.
The most common cause is bacterial infection of hair follicles with staphylococcus aureus bacteria that live on the skin all the time. These generally only cause problems when they enter your body through a wound. Folliculitis may also be caused by viruses, yeast/fungal and even due to inflammation caused by ingrown hairs.
Some well-known risk factors include exposure to poorly-maintained hot tubs or heated swimming pools leading to ‘pseudomonal’ folliculitis. Occasionally, being on prolonged oral antibiotic therapy for acne can predispose patients to ‘gram-negative’ bacterial folliculitis.
Patients with chronic conditions such as diabetes, chronic leukaemia or who are on immunosuppressive medication or HIV positive are more likely to suffer with fungal, viral, or parasitic folliculitis. In your case, given the rash is on your back, this makes it more likely that you are suffering with yeast/fungal ‘malassezia’ folliculitis.
Similar to bacterial folliculitis, there are multiple species of malassezia, a type of yeast present in the normal skin flora that under normal conditions doesn’t cause any trouble but when provoked — in your case by waxing — can cause folliculitis. Living in a hot humid climate, having high sebum production (oily skin) and increased sweating can all be contributing factors to this condition.
The treatment depends on the exact cause, area affected and severity/extent of the condition. Options for malassezia folliculitis include both oral antifungal medication and topical antifungal cream, gels or lotions. Given that you are most likely going to need prescription medication, you will need to see your GP.
Dr Jennifer Grant is a GP with Beacon HealthCheck