Folliculitis Disease

BASICS

DESCRIPTION

Inflammation of hair follicles, often in clusters, often due to local infection or chemical irritation or associated with underlying disease. May be superficial or deep.

System(s) affected: Skin/Exocrine
Genetics: No known genetic pattern
Incidence/Prevalence in USA: Common (no statistics available)
Predominant age: All ages
Predominant sex: Male > Female

SIGNS AND SYMPTOMS

Characteristic lesions are small yellow or gray pustules surrounded by erythema and pierced by a hair. Common folliculitis can appear on any part of the body. Sycosis barbae is folliculitis of the beard area of the shaved face, particularly common in black men. Hot tub folliculitis occurs in the bathing suit area. Eosinophilic pustular folliculitis (EPF) occurs mainly on the trunk of HIV positive patients, but can occur in atopic children sensitive to skin fungi, and as Ofuji's disease in non-HIV patients, especially in Japan.
Lesions are commonly grouped
Eosinophilic folliculitis is often very pruritic, but other folliculitides are only mildly pruritic, or not at all
Patients who are not HIV positive are usually afebrile and without systemic symptoms

CAUSES

Staphylococcus aureus
Pseudomonas aeruginosa in hot-tub folliculitis
Gram negative bacteria in patients on long term antibiotics
Candida albicans in patients on immunosuppressants or long term antibiotic therapy
Dermatophyte fungi - uncommon
Occasionally herpes simplex 1, herpes zoster, molluscum contagiosum virus
Plastic occlusive dressings

RISK FACTORS

Abrasion
Injury
Nearby surgical wounds or draining abscesses
Tight clothing (jeans folliculitis)
Poor hygiene
Exposure to hydrocarbons
Use of hot tubs or saunas
Immunodeficiency
Diabetes mellitus
Lithium therapy
Wax epilation

DIAGNOSIS

LABORATORY

Gram stain - look for bacteria or eosinophils
KOH preparation - looking for budding yeast or hyphae
Culture of pus
Fasting blood sugar
HIV status

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

For common or hot tub folliculitis - suppurative inflammation of hair follicles
For eosinophilic pustular folliculitis there is a perifollicular and perivascular infiltrate in which eosinophils exceed the numbers of neutrophils

SPECIAL TESTS

N/A

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Biopsy if diagnosis is in doubt or in cases resistant to treatment

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Cleanse areas bid with antibacterial soap (e.g. Dial)
Shampoo daily with Selsun Blue for scalp lesions
Apply moist heat to pustules to encourage them to drain
For shaved areas:
- Try electric razor instead of blade, and sterilize electric razor cutting parts with alcohol for 30 minutes daily
- Or change blade of sharp razor daily
- Allow hair to grow
Avoid wax epilatories if they cause a rash
Avoid skin oils or greasy ointments
Avoid topical oils

SURGICAL MEASURES

N/A

ACTIVITY

Full

DIET

No special diet

PATIENT EDUCATION

As listed above under General measures

FOLLOW UP

PREVENTION/AVOIDANCE

Good personal hygiene; avoid sharing a towel or washcloth
Discard any dressings carefully
Avoid causative factors
Find and treat family members or friends who may be a source of reinfection

POSSIBLE COMPLICATIONS

May progress to become furuncles or abscesses

EXPECTED COURSE AND PROGNOSIS

Usually resolves with treatment
May recur in staph carriers. Mupirocin may be required on nares of patient to treat carrier state. Family carriers may also require treatment.
Resistant or severe cases may warrant testing for diabetes mellitus or immunodeficiency

MISCELLANEOUS

ASSOCIATED CONDITIONS

Diabetes mellitus
Immunodeficiency

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

Pruritic folliculitis of pregnancy is a rare disorder that resolves spontaneously after delivery

OTHER NOTES

N/A

ABBREVIATIONS

EPF = eosinophilic pustular folliculitis

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.