Pustules and irritation: Pictorial case study

A patient was becoming irritated by these lesions, explains Dr Jean Watkins.


This patient was worried about the increasing number of small papules and pustules on her legs since she started shaving them a few months before. Initially the lesions had been symptomless, but now they were causing irritation. On inspection with a magnifying glass, a hair could be seen at the centre of the lesions. It was thought to be superficial folliculitis and suggested that with care, it would settle without scarring.


Folliculitis, inflammation and infection of the hair follicles, is a relatively common condition. Staphylococcus aureus is most often involved but other bacteria or herpes simplex virus may be involved, the latter most likely in men who shave near a cold sore.

Folliculitis develops because of obstruction of the pilosebaceous gland, and infection leads to inflammatory pustules.

For patients on long-term antibiotics for acne, Gram-negative folliculitis should be considered.

Other factors are uncut beards, tight clothing, excess sweating, dermatitis or skin trauma, or nasal carriage of Staph aureus. The most commonly affected areas are the axilla, inguinal region, face and beard, scalp and thighs.

Differential diagnoses
  • Keratosis pilaris
  • Milia
  • Contact dermatitis
  • Insect bites
  • Perioral dermatitis
  • Lupus erythematosus


The diagnosis is usually clinical and mild cases tend to resolve if causative factors are avoided. Advice can be given about cleansing shaving equipment and shaving with the direction of hair growth.

A topical antiseptic such as chlorhexidine or povidone-iodine may be helpful. Topical or oral antibiotics may be necessary.

  • Dr Watkins is a retired GP in Hampshire

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