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Folliculitis

Updated : August 24, 2023





Background

Folliculitis is a common skin condition when hair follicles become infected or inflamed. It can appear as small, red bumps or pimples around the hair follicles and can occur on any part of the body where hair grows. A bacterial or fungal infection usually causes folliculitis, but it can also be caused by irritation from shaving or other types of trauma to the skin.

It is generally a non-life-threatening condition that tends to resolve within a few days to weeks. However, it can present challenges for people with compromised immune systems and, in some cases, may progress to more serious diseases. It is essential to keep the affected area clean and dry to prevent the spread of the infection and to avoid picking or squeezing the bumps to prevent further irritation.

 

Epidemiology

Determining the global incidence of folliculitis is difficult because the condition is not always reported or recorded. Specific individuals may be at an increased risk of developing folliculitis due to certain underlying health conditions or behaviors. These may include people with obesity, diabetes, or a history of prolonged use of oral antibiotics, as well as people who are immunocompromised.

Shaving frequently can also increase the risk of developing folliculitis. While gender does not necessarily increase the overall risk of developing folliculitis, some types may be more common in certain genders. For example, some research suggests that women may be more likely to develop certain fungal folliculitis, while men may be more likely to develop certain bacterial folliculitis.

It is usually a mild condition that can be treated effectively with over the counter or prescription medications. In most cases, it does not lead to severe complications or death. However, in rare cases, folliculitis can progress to a more serious condition called cellulitis, a bacterial infection of the skin’s and subcutaneous tissue’s deeper layers.

 

Anatomy

Pathophysiology

The pathogenesis of folliculitis refers to the development and progression of the condition. Folliculitis occurs when the hair follicles become infected or inflamed. Various factors, including bacterial or fungal infections, irritation from shaving or other types of trauma to the skin, and underlying medical conditions such as diabetes or a compromised immune system, can cause it.

Bacterial folliculitis is usually caused by the bacteria Staphylococcus aureus, a common type of bacteria often found on the skin and in the nose. It can enter the hair follicles through cuts or abrasions on the skin or damaged hair follicles. Fungal folliculitis is usually caused by fungi such as Candida or dermatophytes, which can infect the hair follicles. It is more common in warm, moist areas of the body, such as the groin or armpits.

Irritation folliculitis is caused by irritation or skin trauma, such as shaving or wearing tight clothing. This can damage the hair follicles and lead to inflammation. The bacteria or fungus enters the hair follicles through cuts or abrasions on the skin or damaged hair follicles. The infection or irritation causes inflammation of the hair follicles, leading to the development of small, red bumps or pimples around the hair follicles. In some cases, the inflammation can spread to the surrounding skin, developing a rash or redness.

 

Etiology

Folliculitis can be caused by a variety of agents, including bacteria, fungi, and viruses. The most common form of folliculitis is superficial bacterial folliculitis, which is typically caused by the bacteria Staphylococcus aureus. It’s important to note that both the methicillin-sensitive and methicillin-resistant forms of this bacteria can cause folliculitis.

Other possible causes of folliculitis include fungal infections and viral infections, as well as non-infectious factors. Folliculitis caused by the herpes virus presents similarly to bacterial folliculitis, except that papulovesicles or plaques are typically present instead of pustules. Another type of folliculitis is caused by the mite Demodex folliculorum, commonly found on the skin. Many people carry this mite, and this type of folliculitis is somewhat controversial.

Gram-negative bacterial folliculitis, also known as hot tub, folliculitis, is caused by certain types of bacteria, such as Pseudomonas aeruginosa, Klebsiella, and Enterobacter can be found in contaminated water from swimming pools or hot tubs. This type of folliculitis can also occur after long-term use of oral antibiotics.

 

Genetics

Prognostic Factors

The prognosis for folliculitis is generally good, as it is usually treatable. With appropriate treatment, most cases of folliculitis resolve within a few days to a couple of weeks. In some cases, folliculitis may recur, primarily if the underlying cause is not addressed.

It is essential to follow the recommended treatment plan and to practice good hygiene to prevent the spread of infection and reduce the risk of recurrence. If left untreated, folliculitis can lead to more serious complications, such as cellulitis or scarring. In rare cases, folliculitis can also cause hair loss, although this is more likely to occur with severe or recurrent cases of folliculitis.

 

Clinical History

Clinical History

An acute onset of symptoms, such as itching or mild discomfort characterizes superficial folliculitis. In contrast, deep folliculitis typically presents as longer-standing lesions that may cause pain and suppurative drainage. These persistent or recurrent lesions can lead to scarring and permanent hair loss. Additionally, patients may also develop folliculitis following laser hair removal.

The follicular papulopustular eruption is a side effect of certain cancer treatment drugs called epidermal growth factor receptor inhibitors (EGFR). It usually appears within the first two weeks of starting treatment and is most commonly found on the face, scalp, chest, and upper back.

This eruption is associated with symptoms such as itching, pain, and skin peeling. It is also dose-dependent and peaks after 3-4 weeks of treatment. Some patients may experience a negative impact on their quality of life due to this eruption, however, some studies suggest that the acne-like eruption may indicate a good response to the cancer treatment.

Physical Examination

Physical Examination

Superficial folliculitis is characterized by multiple small papules and pustules on an inflamed base, often with a central hair that may not be visible. This type of folliculitis can occur on any hair-bearing area of the body, but is most commonly found on the face, scalp, thighs, underarms, and groin area. When the infection spreads deeper, it may present as red, swollen nodules.

Often, the folliculitis occurs in areas that were shaved or covered, and it can evolve from a superficial to a deep form. The most common superficial form of infectious folliculitis is called impetigo of Bockhart, barbers itch, or folliculitis barbae, caused by Staphylococcus aureus.

This type of infection is usually seen in the bearded area, particularly near the nose, as red, follicular-based papules or pustules that appear in clusters and may rupture, leaving behind a yellow crust. The pustules are often pierced by a hair that can be easily removed from the follicle. This form of folliculitis is more common in people with staphylococci infection.

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Differential Diagnosis

Acne vulgaris

Drug-induced folliculitis

Hidradenitis suppurativa

Keratosis pilaris

Papular urticaria

Papulopustular rosacea

Pseudofolliculitis barbae

Subcorneal Pustular Dermatosis

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Bacterial Folliculitis

Bacterial folliculitis is a common type of folliculitis that is caused by the bacteria Staphylococcus aureus. The specific treatment for bacterial folliculitis will depend on the severity of the condition and the underlying cause. Mild cases of folliculitis can often be treated with topical medications, such as antibiotic ointments or creams, such as mupirocin or retapamulin, applied directly to the affected area.

Antibiotic washes, such as chlorhexidine, are used to clean the affected area. Severe folliculitis or cases that do not respond to topical treatment may require oral antibiotics. Commonly prescribed oral antibiotics for folliculitis include penicillins, such as amoxicillin or dicloxacillin. Cephalosporins, such as cephalexin or cefadroxil, and macrolides, such as erythromycin or azithromycin.

Fungal Folliculitis

Fungal folliculitis is a type of folliculitis caused by a fungal infection of the hair follicles. Mild cases of folliculitis can often be treated topical clotrimazole, miconazole and terbinafine. Severe cases of fungal folliculitis is treated with oral terbinafine, itraconazole, fluconazole.

Viral Folliculitis

Folliculitis that is caused by the herpes simplex virus can be treated using medications that are commonly used to treat outbreaks of herpes, such as acyclovir, valacyclovir, and famciclovir. These medications may be taken orally to help reduce the severity and duration of the infection. It is important to follow the recommended treatment plan and to avoid spreading the infection to others by practicing good hygiene and avoiding close contact with others until the infection has cleared.

 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

 

 

Stem Cell Transplant

Targeted Therapy

Palliative Care

 

 

Medication

 

sodium fusidate 

Oral-Take 250 mg two times every day
2% cream/ointment- Apply topically on the affected area for every 12 hours or every 8 hours a day



 
 

Media Gallary

References

Folliculitis

Updated : August 24, 2023




Folliculitis is a common skin condition when hair follicles become infected or inflamed. It can appear as small, red bumps or pimples around the hair follicles and can occur on any part of the body where hair grows. A bacterial or fungal infection usually causes folliculitis, but it can also be caused by irritation from shaving or other types of trauma to the skin.

It is generally a non-life-threatening condition that tends to resolve within a few days to weeks. However, it can present challenges for people with compromised immune systems and, in some cases, may progress to more serious diseases. It is essential to keep the affected area clean and dry to prevent the spread of the infection and to avoid picking or squeezing the bumps to prevent further irritation.

 

Determining the global incidence of folliculitis is difficult because the condition is not always reported or recorded. Specific individuals may be at an increased risk of developing folliculitis due to certain underlying health conditions or behaviors. These may include people with obesity, diabetes, or a history of prolonged use of oral antibiotics, as well as people who are immunocompromised.

Shaving frequently can also increase the risk of developing folliculitis. While gender does not necessarily increase the overall risk of developing folliculitis, some types may be more common in certain genders. For example, some research suggests that women may be more likely to develop certain fungal folliculitis, while men may be more likely to develop certain bacterial folliculitis.

It is usually a mild condition that can be treated effectively with over the counter or prescription medications. In most cases, it does not lead to severe complications or death. However, in rare cases, folliculitis can progress to a more serious condition called cellulitis, a bacterial infection of the skin’s and subcutaneous tissue’s deeper layers.

 

The pathogenesis of folliculitis refers to the development and progression of the condition. Folliculitis occurs when the hair follicles become infected or inflamed. Various factors, including bacterial or fungal infections, irritation from shaving or other types of trauma to the skin, and underlying medical conditions such as diabetes or a compromised immune system, can cause it.

Bacterial folliculitis is usually caused by the bacteria Staphylococcus aureus, a common type of bacteria often found on the skin and in the nose. It can enter the hair follicles through cuts or abrasions on the skin or damaged hair follicles. Fungal folliculitis is usually caused by fungi such as Candida or dermatophytes, which can infect the hair follicles. It is more common in warm, moist areas of the body, such as the groin or armpits.

Irritation folliculitis is caused by irritation or skin trauma, such as shaving or wearing tight clothing. This can damage the hair follicles and lead to inflammation. The bacteria or fungus enters the hair follicles through cuts or abrasions on the skin or damaged hair follicles. The infection or irritation causes inflammation of the hair follicles, leading to the development of small, red bumps or pimples around the hair follicles. In some cases, the inflammation can spread to the surrounding skin, developing a rash or redness.

 

Folliculitis can be caused by a variety of agents, including bacteria, fungi, and viruses. The most common form of folliculitis is superficial bacterial folliculitis, which is typically caused by the bacteria Staphylococcus aureus. It’s important to note that both the methicillin-sensitive and methicillin-resistant forms of this bacteria can cause folliculitis.

Other possible causes of folliculitis include fungal infections and viral infections, as well as non-infectious factors. Folliculitis caused by the herpes virus presents similarly to bacterial folliculitis, except that papulovesicles or plaques are typically present instead of pustules. Another type of folliculitis is caused by the mite Demodex folliculorum, commonly found on the skin. Many people carry this mite, and this type of folliculitis is somewhat controversial.

Gram-negative bacterial folliculitis, also known as hot tub, folliculitis, is caused by certain types of bacteria, such as Pseudomonas aeruginosa, Klebsiella, and Enterobacter can be found in contaminated water from swimming pools or hot tubs. This type of folliculitis can also occur after long-term use of oral antibiotics.

 

The prognosis for folliculitis is generally good, as it is usually treatable. With appropriate treatment, most cases of folliculitis resolve within a few days to a couple of weeks. In some cases, folliculitis may recur, primarily if the underlying cause is not addressed.

It is essential to follow the recommended treatment plan and to practice good hygiene to prevent the spread of infection and reduce the risk of recurrence. If left untreated, folliculitis can lead to more serious complications, such as cellulitis or scarring. In rare cases, folliculitis can also cause hair loss, although this is more likely to occur with severe or recurrent cases of folliculitis.

 

Clinical History

An acute onset of symptoms, such as itching or mild discomfort characterizes superficial folliculitis. In contrast, deep folliculitis typically presents as longer-standing lesions that may cause pain and suppurative drainage. These persistent or recurrent lesions can lead to scarring and permanent hair loss. Additionally, patients may also develop folliculitis following laser hair removal.

The follicular papulopustular eruption is a side effect of certain cancer treatment drugs called epidermal growth factor receptor inhibitors (EGFR). It usually appears within the first two weeks of starting treatment and is most commonly found on the face, scalp, chest, and upper back.

This eruption is associated with symptoms such as itching, pain, and skin peeling. It is also dose-dependent and peaks after 3-4 weeks of treatment. Some patients may experience a negative impact on their quality of life due to this eruption, however, some studies suggest that the acne-like eruption may indicate a good response to the cancer treatment.

Physical Examination

Superficial folliculitis is characterized by multiple small papules and pustules on an inflamed base, often with a central hair that may not be visible. This type of folliculitis can occur on any hair-bearing area of the body, but is most commonly found on the face, scalp, thighs, underarms, and groin area. When the infection spreads deeper, it may present as red, swollen nodules.

Often, the folliculitis occurs in areas that were shaved or covered, and it can evolve from a superficial to a deep form. The most common superficial form of infectious folliculitis is called impetigo of Bockhart, barbers itch, or folliculitis barbae, caused by Staphylococcus aureus.

This type of infection is usually seen in the bearded area, particularly near the nose, as red, follicular-based papules or pustules that appear in clusters and may rupture, leaving behind a yellow crust. The pustules are often pierced by a hair that can be easily removed from the follicle. This form of folliculitis is more common in people with staphylococci infection.

Differential Diagnosis

Acne vulgaris

Drug-induced folliculitis

Hidradenitis suppurativa

Keratosis pilaris

Papular urticaria

Papulopustular rosacea

Pseudofolliculitis barbae

Subcorneal Pustular Dermatosis

Bacterial Folliculitis

Bacterial folliculitis is a common type of folliculitis that is caused by the bacteria Staphylococcus aureus. The specific treatment for bacterial folliculitis will depend on the severity of the condition and the underlying cause. Mild cases of folliculitis can often be treated with topical medications, such as antibiotic ointments or creams, such as mupirocin or retapamulin, applied directly to the affected area.

Antibiotic washes, such as chlorhexidine, are used to clean the affected area. Severe folliculitis or cases that do not respond to topical treatment may require oral antibiotics. Commonly prescribed oral antibiotics for folliculitis include penicillins, such as amoxicillin or dicloxacillin. Cephalosporins, such as cephalexin or cefadroxil, and macrolides, such as erythromycin or azithromycin.

Fungal Folliculitis

Fungal folliculitis is a type of folliculitis caused by a fungal infection of the hair follicles. Mild cases of folliculitis can often be treated topical clotrimazole, miconazole and terbinafine. Severe cases of fungal folliculitis is treated with oral terbinafine, itraconazole, fluconazole.

Viral Folliculitis

Folliculitis that is caused by the herpes simplex virus can be treated using medications that are commonly used to treat outbreaks of herpes, such as acyclovir, valacyclovir, and famciclovir. These medications may be taken orally to help reduce the severity and duration of the infection. It is important to follow the recommended treatment plan and to avoid spreading the infection to others by practicing good hygiene and avoiding close contact with others until the infection has cleared.

 

 

 

 

 

sodium fusidate 

Oral-Take 250 mg two times every day
2% cream/ointment- Apply topically on the affected area for every 12 hours or every 8 hours a day