Definition
- Infection of hair follicle
- Types:
- Superficial Pustular Folliculitis:
- Aka follicular impetigo or Bockhart impetigo
- Site; Face, Perioral
- Folliculitis barbae:
- Commonly in 20-40 years of age
- Sycosis barbae: Most severe type of this kind
- +/- Marginal Belpharitis and conjunctivitis
- Perifolliculitis capitis:
- Fluctuating
- Interconnecting nodules
- Susceptible to 2nd bacterial/Fungal infection
- Folliculitis keloidalis nuchae, aka acne keloidalis
- Actinic folliculitis:
- 24 hrs after exposing to sunlight
- Malassezia folliculitis:
- Small
- Scattered
- Itchy
- Follicular papules
- Mostly on the back, chest, posterior arms and +/- neck
- Slowl growth and finally becomes pustular
- Epidermal Growth Factor Receptor (EGFR inhibitors) induced folliculitis
- Eg: Gefitinib, Cetuximab
- 1-3 weeks after administering the medication
- Superficial Pustular Folliculitis:
Epidemiology
- Chronic Cellulitis
- Mostly between 16- 25 y
- African Descent
- Gender: Men more severe on Average
- Prevalence: 45%-83% among African populations
DDx
- Tinea Corporis infection:
- Pustular Miliaria
Causes
- Idiopathic
- Ingrowth hair under skin
- Fungal
- Bacterial:
- Staph aureus (Most Common)
- Pseudomonas aeruginosa (In hot tubs)
- Skin friction
- Parasitic
- Viral
- HIV => Eosinophilic folliculitis
Risk Factors
- Adipose gland adjacent to hair follicle occlusion
- Ingrowth hair under skin
- Shaving
- Cutaneous abscess drainage
- Surgical wound drainage
- Plastic/plaster dressing
- Sun Exposure
Complications
- Usually no scaring
- Furuncles or carbuncles
- Abscess
- Painful cysts requiring surgical drainage
Presenting symptoms
- Most common sites:
- Head
- Neck
- Buttock
- Trunk
- Tender in Palpation
- Pruritus
- Superficial pustule
- Inflammatory nodule
- Hair follicle is seen mostly at the centre of the inflammation
- Superficial Pustular Folliculitis:
- Site; Face, Perioral
- Folliculitis barbae:
- +/- Marginal Belpharitis and conjunctivitis
- Perifolliculitis capitis:
- Fluctuating
- Interconnecting nodules
- Susceptible to 2nd bacterial/Fungal infection
- Actinic folliculitis:
- 24 hrs after exposing to sunlight
- Malassezia folliculitis:
- Small
- Scattered
- Itchy
- Follicular papules
- Mostly on the back, chest, posterior arms and +/- neck
- Slow growth and finally becomes pustular
- Epidermal Growth Factor Receptor (EGFR inhibitors) induced folliculitis
- Eg: Gefitinib, Cetuximab
- 1-3 weeks after administering the medication
Signs
- Pain
- Itching
Red flags
- Swollen
- Painful
- Sever tenderness
- Fever
- Sub-cutaneous abscess
- Immuno-compromised patients
- HIV +Ve Patients
Lab work ups
- Diagnosis is mainly through P/E
- If suspicious to Eosinophilic Folliculitis, R/O Immunosuppression:
- HIV ELISA
- CBC with diff
- If suspicious to Fungal cause:
- KOH smear preparation
Diagnostics
- No imaging required
- Diagnosis is mainly through P/E and also Hx
Management
- Eliminate underlying cause:
- Remove plaster
- Replace/ remove the plastic dressing
- Mupirocin topical ointment
- Aluminum Acetate 1/20 or 1/40 solution
- Soak 6 layers of gauze in the solution
- Change dressing q 2-3 hrs
- Antibiotics:
- Dicloxacillin: 250-500 mg PO q6h X 10 days
- Erythromycin: 250-500 mg PO q6hX 10 days
- Topical steroid creams:
- Indication: Severe inflammation
- If eosinophilic folliculitis:
- Itraconazole: 100-400 mg po qd
- Anti Retroviral Therapy (ART)
- Isotertinoin: 40-80 mg/day, 0.5–1.2 mg/kg per day)
- UVB Phototherapy
- Permethrine 5% topical cream
- Topical antihistamines and Corticosteroids
References
- Guidelines on the Treatment of Skin and Oral HIV-Associated Conditions in Children and Adults. Geneva: World Health Organization; 2014. 7, Evidence and recommendations on eosinophilic folliculitis. Available from: https://www.ncbi.nlm.nih.gov/books/NBK305422/
- Sun, K. L., & Chang, J. M. (2017). Special types of folliculitis which should be differentiated from acne. Dermato-endocrinology, 9(1), e1356519. doi:10.1080/19381980.2017.1356519
- Luelmo-Aguilar J, Santandreu MS. Folliculitis: recognition and management. Am J Clin Dermatol. 2004;5(5):301-10. Review. PubMed PMID: 15554731.
- Laureano AC, Schwartz RA, Cohen PJ. Facial bacterial infections: folliculitis. Clin Dermatol. 2014 Nov-Dec;32(6):711-4. doi: 10.1016/j.clindermatol.2014.02.009. Epub 2014 Mar 1. Review. PubMed PMID: 25441463.
- Prasad P, Anandhi V, Jaya M. Chronic folliculitis – A clinico-epidemiological Indian J Dermatol Venereol Leprol. 1997 Sep-Oct;63(5):304-6. PubMed PMID: 20944361.