Folliculitis

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Folliculitis
Isolated folliculitis.jpg
A single spot of folliculitis
SpecialtyDermatology
SymptomsTender small pustule or red bump[1][2]
ComplicationsCellulitis, abscess[1]
TypesBacterial folliculitis, hot tube folliculitis, fungal folliculitis, malassezia folliculitis[1][2]
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 a small pustule or red bump.[1] These are generally tender.[2] The condition may occur anywhere on hair covered skin.[1][2] Complications may 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]

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 tube use, the outbreak will generally resolve without treatment within 10 days.[1] The condition is common.[1]

Signs and symptoms

Folliculitis post shaving

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,[3] 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

Fungal

Viral

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.[6]

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. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 Winters, RD; Mitchell, M (January 2020). "Folliculitis". PMID 31613534. Cite journal requires |journal= (help)
  2. 2.0 2.1 2.2 2.3 "Folliculitis | DermNet NZ". dermnetnz.org. Retrieved 14 November 2020.
  3. "NHS Direct".
  4. MedlinePlus Encyclopedia: Hot tub folliculitis
  5. "Severe Acne: 4 types". American Academy of Dermatology. Archived from the original on February 9, 2011. Retrieved December 15, 2010.
  6. 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.

External links

Classification
External resources