Folliculitis

Folliculitis
A single spot of folliculitis
SpecialtyDermatology
SymptomsTender small pustule or red bump, itch[1][2]
ComplicationsCellulitis, abscess[1]
TypesBacterial folliculitis, hot tub folliculitis, fungal folliculitis, malassezia folliculitis[1][3]
Risk factorsDiabetes, obesity, antibiotic use, poor immune function, shaving[1]
Diagnostic methodBased on symptoms and examination[1]
Differential diagnosisAcne, papulopustular rosacea, pseudofolliculitis barbae, keratosis pilaris[1]
PreventionGood hygiene[1]
TreatmentDepends on the cause, often conservative[1]
PrognosisGenerally good[1]
FrequencyCommon[1]

Folliculitis is infection or inflammation of one or more hair follicles resulting in one or more small pustules or red bumps.[1] These are generally tender and may be itchy.[2] The condition may occur anywhere on hair covered skin.[1][3] Complications include cellulitis or abscess.[1]

It most commonly occurs due to a bacterial infection though less commonly may result from a fungal, viral, or noninfectious cause.[1] Risk factors include diabetes, obesity, antibiotic use, poor immune function, shaving and certain medications like lithium.[1] Diagnosis is generally based on symptoms and examination.[1] A swab of a pustule for culture may identify the causative organism.[4]

Treatment depends on the underlying cause but is often conservative.[1] When due to Staph. aureus, while a few lesions may resolve on their own, larger numbers of lesions may be treated with antibiotic cream or pills.[1] When due to hot tub use, the outbreak will generally resolve without treatment within 10 days.[1] The condition is common.[1]

Signs and symptoms

  • Folliculitis post shaving
    Folliculitis post shaving
  • Folliculitis
    Folliculitis
  • Folliculitis due to vemurafenib
    Folliculitis due to vemurafenib
  • Wetsuit folliculitis
    Wetsuit folliculitis
  • Candida albicans folliculitis
    Candida albicans folliculitis

Complications

Condition can develop into a more severe skin condition such as cellulitis or abscess.[1]

Causes

Most carbuncles, boils, and other cases of folliculitis develop from Staphylococcus aureus.[1]

Folliculitis starts with the introduction of a skin pathogen to a hair follicle. Hair follicles can also be damaged by friction from clothing, an insect bite,[5] blockage of the follicle, shaving, or braids that are too tight and too close to the scalp. The damaged follicles are then infected by Staphylococcus. Folliculitis can affect people of all ages.

Iron deficiency anemia is sometimes associated with chronic cases.

Bacterial

  • Staphylococcus aureus folliculitis.[1]
  • Hot-tub folliculitis is caused by the bacterium Pseudomonas aeruginosa.[6] The folliculitis usually occurs after sitting in a hot tub that was not properly cleaned before use. Symptoms are found around the body parts that sit in the hot tub: the legs, hips, chest, buttocks, and surrounding areas. Symptoms are amplified around regions that were covered by wet clothing, such as bathing suits.
  • Sycosis vulgaris, Sycosis barbae or Barber's itch is a staphylococcus infection of the hair follicles in the bearded area of the face, usually the upper lip. Shaving aggravates the condition.
  • Gram-negative folliculitis may appear after prolonged acne treatment with antibiotics.[7]

Fungal

Main article: Fungal folliculitis

Viral

  • Herpetic folliculitis rarer, but may occur when herpes simplex virus infection spreads to nearby hair follicles appearing in groups or clusters,[1] mostly around the mouth.

Non-infectious

  • Pseudofolliculitis barbae is a disorder occurring when hair curves back into the skin and causes inflammation.
  • Eosinophilic folliculitis may appear in persons with impaired immune systems.
  • Folliculitis decalvans or tufted folliculitis usually affects the scalp. Several hairs arise from the same hair follicle. Scarring and permanent hair loss may follow. The cause is unknown.
  • Reaction to Demodex mite infestation may occasionally be misdiagnosed as folliculitis.
  • Folliculitis keloidalis scarring on the nape of the neck. Most common among males with curly hair.
  • Oil folliculitis is inflammation of hair follicles due to exposure to various oils and typically occurs on forearms or thighs. It is common in refinery workers, road workers, mechanics, and sheep shearers. Even makeup may cause it.
  • Malignancy may also be represented by recalcitrant cases.[8]

Diagnosis

Histopathology of folliculitis of unknown cause, with giant cells surrounding a hair follicle.

Diagnosis is generally based on symptoms and examination.[1]

Treatment

Most simple cases will resolve on their own but first line treatments are typically topical medications.[1]

  1. Topical antiseptic treatment is adequate for most cases
  2. Topical antibiotics, such as mupirocin or Neomycin/polymyxin B/bacitracin ointment may be prescribed. Oral antibiotics may also be used.
  3. Some patients may benefit from systemic narrow-spectrum penicillinase-resistant penicillins (such as dicloxacillin in US, or flucloxacillin in UK)
  4. Fungal folliculitis may require an oral antifungal such as Fluconazole. Topical antifungals such as Econazole Nitrate may also be effective.[1]

Folliculitis may recur even after symptoms have gone away.

See also

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Winters, RD; Mitchell, M (January 2020). "Folliculitis". PMID 31613534. Archived from the original on 2022-09-21. Retrieved 2023-04-29. {{cite journal}}: Cite journal requires |journal= (help)
  2. 1 2 Bolognia, Jean L.; Schaffer, Julie V.; Duncan, Karynne O.; Ko, Christine (2021). "31. Folliculitis". Dermatology Essentials (2nd ed.). Elsevier. pp. 282–297. ISBN 978-0-323-70971-2. Archived from the original on 2023-07-18. Retrieved 2023-07-16.
  3. 1 2 "Folliculitis | DermNet NZ". dermnetnz.org. Archived from the original on 12 November 2020. Retrieved 14 November 2020.
  4. ↑ de Moll, Helen H.; Phelps, Robert G. (2022). "86. Folliculitis". In Lebwohl, Mark G.; Heymann, Warren R.; Coulson, Ian H.; Murrell, Dedee F. (eds.). Treatment of Skin Disease (6th ed.). Elsevier. p. 291. ISBN 978-0-7020-8210-8. Archived from the original on 2023-07-15. Retrieved 2023-07-16.
  5. ↑ "NHS Direct". Archived from the original on 2013-08-29. Retrieved 2013-08-31.
  6. ↑ MedlinePlus Encyclopedia: Hot tub folliculitis
  7. ↑ "Severe Acne: 4 types". American Academy of Dermatology. Archived from the original on February 9, 2011. Retrieved December 15, 2010.
  8. ↑ Folliculitis, follicular mucinosis, and papular mucinosis as a presentation of chronic myelomonocytic leukemia. Rashid R, Hymes S. Dermatol Online J. 2009 May 15;15(5):16.
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