Benzoyl peroxide for folliculitis: does it help?

Folliculitis is an infection or inflammation of the hair follicles, the small openings each hair grows from. It looks a lot like acne, and benzoyl peroxide, an acne medicine that kills germs on the skin, is a common thing people try on it. The honest answer is that benzoyl peroxide kills the germs behind many cases of folliculitis in lab tests, it helped razor bumps in one trial, and dermatologists suggest it for some related conditions. It has not been tested in trials of ordinary bacterial folliculitis. This guide sets out what is known, what is not, and when to see a doctor instead. For the ingredient as a whole, see the benzoyl peroxide guide.

Skinli gives general education. A doctor is the right person to diagnose folliculitis, which can look like acne and several other skin conditions.

What folliculitis is

The American Academy of Dermatology (AAD) calls folliculitis "a common skin infection that develops in the hair follicles," and says it "can appear anywhere on the skin, except for our palms and soles." It starts when follicles are damaged: "Once damaged, it's easy for germs to get inside the follicles and cause an infection. A common source of infection is Staph aureus, which is found on our skin."

MedlinePlus says "most of the time, the damaged follicles become infected with staphylococci (staph) bacteria," and that folliculitis can also be caused by a fungus. The AAD lists common causes:

• a hot tub that is not kept clean, which causes "hot tub folliculitis"
• shaving, plucking or waxing
• tight clothing or equipment
• medicine applied to the skin, such as coal tar
• medicine you take
• weight gain

Symptoms vary. The AAD says "you may not feel anything," or the bumps may itch or hurt.

What benzoyl peroxide does to the germs

Benzoyl peroxide kills germs by a chemical reaction. The prescription labels call it "an oxidizing agent with bactericidal and keratolytic effects," meaning it kills bacteria and loosens dead skin cells.

A 2021 lab study in The Journal of Dermatology exposed nine kinds of germs to benzoyl peroxide for 1 hour. Staphylococcus aureus, Staphylococcus epidermidis, the acne bacterium and three Malassezia yeasts were "markedly decreased," while two other bacteria, E. coli and Pseudomonas aeruginosa, were unchanged. The authors concluded that benzoyl peroxide killed the first group quickly and strongly. Two limits matter. The test was done in lab dishes, not on skin. And most of the authors work for Maruho, a drug company. The study shows benzoyl peroxide can kill these germs; it cannot show how well it clears folliculitis on a person.

What the trials show

Bacterial folliculitis and boils. A 2021 Cochrane review, which pools every good trial it can find, looked for studies of "topical antiseptics, such as topical benzoyl peroxide" in bacterial folliculitis and boils. It found 18 trials in total, and it reported: "We found no studies that evaluated antiseptics." Its authors concluded that the benefits of treatments such as antiseptics "are unclear, because too few studies have investigated this."

Razor bumps. Razor bumps, or pseudofolliculitis barbae, are ingrown beard hairs that inflame the follicle. MedlinePlus explains that when curly beard hairs are cut too short, "they may curve back into the skin and cause inflammation." In a 2004 trial, 88 men with razor bumps used either a prescription gel with 5% benzoyl peroxide and 1% clindamycin, or a gel without medicine, twice a day for 10 weeks. The medicated gel reduced bumps more at weeks 2, 4 and 6. Among Black participants on the medicated gel, bumps fell by 38.2% at week 2 and 63.9% at week 10. The authors called it a "pilot study" and said the results "warrant further investigation."

Condition	Evidence for benzoyl peroxide	Source
Bacterial folliculitis	No trials found	2021 Cochrane review
Fungal folliculitis	Kills Malassezia in the lab only	2021 lab study
Razor bumps	One trial of a prescription gel with clindamycin	2004 trial in Cutis
Hidradenitis suppurativa	Suggested as a germ-killing wash	AAD self-care advice
Bumps at the back of the neck and scalp	Suggested as a wash to prevent infection	AAD advice on acne keloidalis nuchae

Where dermatologists suggest a benzoyl peroxide wash

The AAD suggests benzoyl peroxide washes for two conditions that involve hair follicles:

• Hidradenitis suppurativa, a long-term condition that causes painful lumps under the skin. The AAD says to "wash your skin with an antimicrobial wash," and that "one product that can decrease the bacteria on your skin is an acne wash that contains benzoyl peroxide or zinc pyrithione." It also says to stop scrubbing, because "scrubbing causes inflammation."
• Acne keloidalis nuchae, bumps at the back of the neck and scalp. The AAD says "using a product like a gentle, foaming benzoyl peroxide wash (an antimicrobial cleanser) helps to prevent infection."

Both call for a dermatologist's diagnosis first.

Store products sold for folliculitis

DailyMed lists some store creams sold for folliculitis with 5% benzoyl peroxide. One lists its uses as "for the treatment of folliculitis" and "helps prevent recurrence." These products are filed under the FDA's category for store acne drugs. The FDA rule for that category lists the use as "for the treatment of acne" or "for the management of acne." Skinli found no FDA rule or trial that supports benzoyl peroxide as a store treatment for folliculitis. The listing shows the claims the company made.

If you try it

If a doctor agrees that benzoyl peroxide is reasonable for your bumps, the acne label directions are a sensible guide:

1. Start low. Store products run from 2.5% to 10%. The AAD suggests 2.5% to start for acne, because stronger products "can cause dryness and flaking."
2. Start once a day. The FDA label says to start with one application a day and to cut back to "once a day or every other day" if dryness or peeling bothers you.
3. A wash for large areas. On the back and buttocks, a wash is easier to spread. Contact time matters: a 2010 study found an 8% wash rinsed off after a short time did not lower bacteria on the back, while a 2012 study found 2 minutes of contact with a 9.8% foam did. Skinli's guide to acne body wash explains how to use one.
4. Protect fabric. Benzoyl peroxide bleaches hair and dyed fabric, so use white towels and rinse well. See does benzoyl peroxide bleach.
5. Remove the cause. The AAD says folliculitis often clears on its own when you stop what caused it. When shaving, plucking or waxing is the cause, "you'll want to stop doing these things for 30 days." Warm compresses "at least 3 to 4 times a day," for "15 to 20 minutes each time," help the skin clear faster.
6. Mind the direction of hair. When applying any medicine, the AAD suggests "applying the medication in the same direction in which your hair grows" and not covering the area with a bandage or clothing when possible, to lower the risk of folliculitis.

Preventing folliculitis

The AAD says folliculitis can sometimes be prevented, and its tips do not involve any medicine:

• Wear loose clothing when it is hot and humid, and change out of tight workout clothes and shower right after exercise.
• Use well-kept hot tubs. If you are unsure whether the acid and chlorine levels are controlled, the AAD suggests skipping the hot tub.
• Wash your swimsuit or wetsuit after each use and let it dry completely before you wear it again.
• Shave with care, because shaving is a common cause.

Folliculitis, acne or something else?

The AAD says a dermatologist can confirm folliculitis because "the infected hair follicles can look like another skin condition, such as acne." Fungal acne is a folliculitis caused by yeast, and MedlinePlus says folliculitis treatment may include an antifungal medicine. Butt acne can be folliculitis, and true acne can appear there too. If your bumps are true acne on the face, the rest of this hub applies, starting with the strengths guide.

When to see a doctor

See a doctor if the bumps are painful, spreading, full of pus, or come with fever; if they follow a hot tub and do not settle; if they keep coming back; or if you are not sure what they are. The AAD says "some people need medication, such as an antibiotic, to clear the folliculitis." MedlinePlus says treatment may include "antibiotics applied to the skin or taken by mouth, or an antifungal medicine." Skinli's free acne plan is built for facial acne and cannot diagnose folliculitis. A doctor is the right person to diagnose and treat your skin.