Why are there small red bumps in beard area when I wake up?

Question

Hello doctor,

Every morning, I wake up and the beard area of my face is full of small red bumps. This has happened for many months now. I wash my face with Cetaphil cleanser and sometimes Ketoconazole shampoo. This removes some of the pus but my face is still red and a little itchy. I took several different antibiotics for severe acne in my teenage years and early 20s. I shave using an electric shaver with a guard so the blade never touches the skin and the hair is still about 2 mm long. What to do? Please help.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

I saw your pictures (attachment removed to protect patient identity). This condition is called folliculitis. It is the infection of hair follicles that form red bumps and pustules around the opening of hairs on the skin surface. Most of the time the infection is bacterial in origin, caused by Staphylococcus or Streptococcus. Sometimes the yeast in the skin can also be the cause for folliculitis. The treatment for folliculitis includes:

Topical Clindamycin (antibiotic) 1 % lotion, apply to the affected area over face in the morning after washing face. Use mild facial cleanser. Cetaphil cleanser is good. You can continue using it.
Topical Miconazole (antifungal) 2 % gel, apply to the affected area over face and neck at night.
Oral tablet Keflex (Cephalexin) 500 mg. Take one pill two times a day after breakfast and dinner for one week. Take this tablet only if you are not allergic to Penicillin group of medicine.

Before applying the medication, after washing face, clean the area with warm saline water using clean cotton cloth or gauze (never cotton, because cotton gets stuck to the skin). Dip the cloth or gauze in warm saline, gently clean the area. Then apply Clindamycin lotion in the morning and Miconazole gel at night. Do not prick the lesions. Wash face very gently. Avoid close shaving or reverse shaving. If this problem is occurring repeatedly then you need to undergo swab testing for culture and sensitivity of the bacteria inside the pus.

Other possibilities are acne and Rosacea. Both can have pustules. Acne involves almost whole of face, chest, and back. Rosacea involves center of the face, chin, nose, and prominence of the cheek. Trying to rule out these two conditions. Can you please answer these questions:

Is this limited only to your beard area? Do you have similar lesions on back, upper face, and chest?
Do you get flushing of the face on exposure to sunlight, on eating spicy food, or on drinking hot beverages?

I hope this information will help you.

Thanks.