The internet has broken over getting folliculitis after waxing treatment and exactly what causes it. Some people call it a histamine reaction after waxing treatment, some call it in-growns, some razor burn and yet others just call it after brazilian wax bumps. One thing that we all agree on is that the symptoms ARE a form of folliculitis. In this article, we will discuss what folliculitis is, how you can help prevent it as an esthetician, and if it does occur, the potential treatments to relieve symptoms that can help get your client back to normal.
WHAT IS FOLLICULITIS?
Let's break down the term folliculitis:
Follicul = follicle
Itis = inflammation
Now the definition makes sense, right?
WHAT ISN'T FOLLICULITIS?
Ingrown hairs only typically appear 24 hours or later after a treatment. These are not the same as folliculitis. A small amount of hair is trapped beneath the skin, causing an infection.
Allergies often show up at the exact same time as folliculitis, but are actually the least common issue that actually happens after waxing. If the bumps subside within 1 day and are not spreading, it is very unlikely an allergic reaction. However, if you are unsure, please consult a physician.
WHAT CAUSES FOLLICULITIS?
Folliculitis is usually caused by either a bacterial or fungal infection. At first, it may look like small, red bumps or white-headed pimples around hair follicles. The condition isn't serious in nonimmune compromised clients. It is in fact itchy, sore, and unsightly. Severe cases or immuno-compromised individuals should seek professional medical intervention. The two main types of folliculitis are superficial and deep. The superficial type involves part of the follicle, and the deep type involves the entire follicle and is usually more severe.
SYMPTOMS OF AFTER WAX HISTAMINE REACTIONS AND FOLLICULITIS
Histamine or utricaria is the body's immune response to trauma or the introduction of an allergen.
How does histamine effect your client during a wax?
When we pull the hair from the follicle, we damage the follicle's surrounding tissues. It is this damage that triggers the histamine response. A controlled histamine response can help nourish and heal the injured tissue. However, the histamine response after waxing can become out of control. This is when it causes more severe irritation.
What does the histamine reaction do to your clients?
When a more severe histamine reaction occurs, your client may experience a raised histamine rash, razor bumps, or itchy, sore, and painful areas. Histamine reaction doesn't always present itself as hives. It can look like the picture on the left, and most of them will when it comes to waxing.
Most common after waxing folliculitis:
Bacterial folliculitis. This common type many times can be associated with itchy, white pus bumps after Brazilian wax. It occurs when hair follicles become infected with bacteria. Staph can be a big culprit in bacterial folliculitis. Staph lives on all of us. This is the most common infection after waxing.
Histamine Reaction - Post-Waxing
Uncommon folliculitis you will see:
Hot tub folliculitis (pseudomonas folliculitis). With this type you may develop a rash of red, round, itchy bumps one to two days after exposure to the bacteria that causes it. Hot tub folliculitis is caused by pseudomonas bacteria, which is found in many places, including hot tubs and heated pools, in which the chlorine and pH levels aren't well-regulated.
Razor bumps (pseudo folliculitis barbae). This is a skin irritation caused by ingrown hairs after waxing. It mainly affects men with curly hair who shave too close and is most noticeable on the face and neck.
People who get bikini waxes may develop barber's itch in the groin area. This condition may leave dark raised scars (keloids). This can also be known as after Brazilian razor bumps.
Pityrosporum (pit-ih-ROS-puh-rum) folliculitis. This type produces chronic, red, itchy pustules on the back and chest and sometimes on the neck, shoulders, upper arms, and face. This type is caused by a yeast infection. This needs medical attention as we cannot diagnose or treat.
Forms of deep folliculitis include:
Sycosis barbae. This type affects males who have begun to shave.
Gram-negative folliculitis. This type sometimes develops if you're receiving long-term antibiotic therapy for acne.
Boils (furuncles) and carbuncles. These occur when hair follicles become deeply infected with staph bacteria. A boil usually appears suddenly as a painful pink or red bump. A carbuncle is a cluster of boils.
Eosinophilic (e-o-sin-o-FILL-ik) folliculitis. This type mainly affects people with HIV/AIDS. Signs and symptoms include intense itching and recurring patches of bumps and pimples that form near hair follicles of the face and upper body. Once healed, the affected skin may be darker than your skin was previously (hyperpigmented). The cause of eosinophilic folliculitis isn't known.
NOTE: The previous 3 forms of folliculitis require you to STOP service and refer to a doctor. DO NOT service again without a doctor’s note.
HOW TO HELP PREVENT FOLLICULITIS
Proper post-waxing care, especially after Brazilian wax care, is essential to ensure a clean wax and prevent this type of reaction in clients.
This means always using a high-quality pre and post cleanser as well as a high-quality pre and post oil.
Be sure to treat all the skin in the areas you are treating. Your clients will appreciate the attention to detail you provided and the knowledge you have relating to preventing folliculitis.
Always take all the precautions you can to prevent this condition. However, know that even when we take the best precautions to prevent folliculitis, there is always a possibility that it could still present. In that case, we must help our clients through the issues they may experience.
How you can do that is by offering great home care products for them to use. You want to look for a product that has limited ingredients, doesn't contain comogenic ingredients such as kelp and is a chemical exfoliant. Manual exfoliants like scrubs and loofahs don't typically help drastically with folliculitis. A chemical exfoliant will work from under the skin where the hair or bacteria is trapped.
HOW TO TREAT FOLLICULITIS
If your client experiences a minor to moderate histamine reaction after waxing, making these recommendations to them can help alleviate the symptoms:
1) Change sheets
2) Wear clean shirts that have been washed with fragrance free detergent
3) Limit activities that cause sweating
4) Take a cool shower with an antibacterial soap 2x a day for 3 days
*You can also consider recommending that they apply a topical antibiotic and antihistamine, but only with the approval of their doctor.
If symptoms don't clear up in a few days, advise medical intervention. Be very careful about suggesting over-the-counter remedies. Word it just the right way to protect yourself from liability.
Why recommend an antihistamine if it is a bacterial infection? The folliculitis could have been caused by an after waxing histamine reaction and morphed to a bacterial reaction. Suggesting both ointments will alleviate symptoms of both issues.
You could phrase it like this to your client: "I would recommend you do the ‘the first four steps listed above’ as well as talking to your doctor about applying Neosporin or antibiotic ointment, and an anti-histamine ointment."
How can you help your client with more severe folliculitis symptoms after waxing?
You must be very careful when you talk about treating or recommending anything for folliculitis or histamine reactions. Recommending specific treatments for after-waxing folliculitis could cause legal problems for you down the road. You do not want to get caught in a 'well she told me to and it went poorly' lawsuit. Do your absolute best to STAY IN SCOPE OF PRACTICE.
With that said, there are a few very general forms of treatment you can recommend. If your client is experiencing more severe symptoms of folliculitis, making these recommendations can help alleviate the symptoms:
- Change sheets
- Wear clean shirts that have been washed with fragrance free detergent
- Limit activities that cause sweating
- Take a cool shower with an antibacterial soap 2x a day for 3 days
- Apply a topical antibiotic and antihistamine (only with the approval of their doctor).
- After 48 hours, exfoliate at least 1x a day for a few days.
- Do NOT pick or itch the area - this will certainly make the after waxing histamine reaction worse.
- A calamine lotion can help with itching.
- Use a chemical exfoliant in between waxing.
Folliculitis symptoms can be moderate or they can be more severe, whether they're just after Brazilian wax bumps, white pus bumps after Brazilian wax, or a histamine reaction after waxing.
We as estheticians need to be responsible for them, prevent them where possible, educate clients about what they are, and make sensible recommendations to help clients get past any trauma or allergic reactions from waxing.
The way you handle these situations will be the difference between whether they return for another service or go somewhere else.