If after several days, a breakout does not seem to be improving, a consultation with a doctor or dermatologist should be booked. He or she will assess the affected areas, examining the skin.
During the consultation, he or she will discuss the nature of symptoms, how long ago they began, whether they have happened before, and address any potential underlying causes. A doctor will wish to determine whether symptoms have been consistent or occasional (whether they flare up, resolve and reappear thereafter), if a person is experiencing any itching, tenderness or painful sensations, as well as if any homecare measures have been attempted to improve the breakout (and whether these attempts have been successful or not).
A doctor may wish to try and determine a possible history of dermatitis, whether or not a person works with or regularly uses substances which aggravate the skin and / or hair follicles, or if there has been any recent exposure to something causing an infectious reaction (such as using a hot tub or public swimming pool).
A doctor will conduct a discussion which helps to detail a patient’s full medical history. If after examining the skin, it is evident that there may be an infectious cause, he or she may take swabs from the pustules (for microbial culture analysis – usually if the cause is suspected as being either bacterial or fungal) or a skin biopsy for laboratory examination. Sometimes this may only be done if initial treatment does not appear to help resolve a breakout. A sample of extracted hair may also be taken from the affected areas in order to be examined. Hair samples are microscopically analysed using potassium hydroxide so as to determine a potentially infectious cause.
A skin biopsy is rarely required, and may only be recommended should a doctor wish to rule out any other potential medical conditions, such as impetigo (a highly contagious skin infection, usually presenting as facial sores).
A diagnosis can generally be made with a skin examination along with a medical history review, sometimes involving a dermoscopy or dermatoscopy (microscopic evaluation of the skin’s surface). The technique is useful for identifying and evaluating pigmented skin lesions in a non-invasive way. Colours and microstructures of the skin can be better analysed using this method than can be achieved with the naked eye.
It is rare for blood tests to be recommended for the diagnosis of folliculitis, and this may only be done if an individual’s condition presents a specific and necessary reason for testing (either to diagnose or rule out possible underlying conditions).