result is a tender red spot, often with a surface pustule.
may be superficial or deep
can affect anywhere there are hairs, including chest, back, buttocks, arms, and legs.
Acne and its variants are also types of folliculitis.
Causes
Bacterial
mostly due to Staphylococcus aureus.
If the infection involves the deep part of the follicle, it results in a painful boil.
treatment
careful hygiene
antiseptic cleanser or cream
antibiotic ointment
oral antibiotics
treat as Impetigo (as per eTG)
localised skin sores,:
mupirocin 2% ointment or cream topically to crusted areas, 8-hourly for 5 days
multiple skin sores or recurrent infection
dicloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 7 days OR
flucloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 7 days OR
cefalexin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 7 days. OR
trimethoprim+sulfamethoxazole 160+800 mg (child 1 month or older: 4+20 mg/kg up to 160+800 mg) orally, 12-hourly for 3 days
Spa pool folliculitis
due to Pseudomonas aeruginosa
Buttock folliculitis
quite common in males and females.
Acute buttock folliculitis
bacterial in origin (like boils)
resulting in red painful papules and pustules
clears with antibiotics.
Chronic buttock folliculitis
does not often cause significant symptoms
but it can be very persistent.
antiseptics, topical acne treatments, peeling agents such as alpha-hydroxy acids, long courses of oral antibiotics and isotretinoin can help buttock folliculitis = not always effective
Rx – permanent hair reduction by laser or intense pulsed light (IPL) is best
Yeasts
Pityrosporum ovale, also known as Malassezia
most common
Malassezia folliculitis (pityrosporum folliculitis) is an itchy acne-like condition usually affecting the upper trunk of a young adult.
Treatment
avoiding moisturiser
stopping any antibiotics
start topical antifungal or oral antifungal medication for several weeks
Candida albicans
occurs in skin folds (intertrigo) or the beard area
Fungi
Ringworm of the scalp (tinea capitis) usually results in scaling and hair loss, but sometimes results in folliculitis.
Treatment
oral antifungal agent for several months
Viral infections
herpes simplex virus
tends to be tender and resolves without treatment in around ten days.
Severe recurrent attacks may be treated with aciclovir and other antiviral agents.
Herpes zoster (the cause of shingles)
may present as folliculitis with painful pustules and crusted spots within a dermatome (an area of skin supplied by a single nerve).
Rx:
treated with high-dose aciclovir.
Molluscum contagiosum
common in young children, can present with follicular umbilicated papules, usually clustered in and around a body fold.
Molluscum may provoke dermatitis
Parasitic infection
demodicosis
colonisation by hair follicle mites (demodex)
on the face or scalp of older or immunosuppressed
scabies
often provokes folliculitis, as well as non-follicular papules, vesicles and pustules
Irritation from regrowing hairs
arise as hairs regrow after
shaving (called shaving rash, frequently itchy, Rx: stop hair removal, and not begin again for about three months after the folliculitis has settled.use a gentle hair removal method, such as a lady’s electric razor. Avoid soap and apply plenty of shaving gel, if using a blade shaver.)
waxing
electrolysis
plucking
Swabs taken from the pustules are sterile
Folliculitis due to contact reactions
Occlusion
Paraffin-based ointments, moisturisers, and adhesive plasters may all result in a sterile folliculitis.
If a moisturiser is needed, choose an oil-free product, as it is less likely to cause occlusion.
Chemicals
Coal tar, cutting oils and other chemicals may cause an irritant folliculitis.
Avoid contact with the causative product.
Topical steroids
Overuse of topical steroids may produce a folliculitis.
Perioral dermatitis is a facial folliculitis provoked by moisturisers and topical steroids.
Perioral dermatitis is treated with tetracycline antibiotics for six weeks or so
Immunosuppression
Eosinophilic folliculitis arise in some immune-suppressed individuals.
Drugs
corticosteroids (steroid acne)
androgens (male hormones)
adrenocorticotrophic hormone (ACTH)
lithium
isoniazid (INH)
phenytoin
B-complex vitamins
Folliculitis due to inflammatory skin diseases
Lichen planus
Discoid lupus erythematosus
Folliculitis decalvans
Folliculitis keloidalis
Acne variants/Acne and acne-like (acneform) disorders
are also forms of folliculitis. These include:
Acne vulgaris
Nodulocystic acne
Rosacea
Scalp folliculitis
Chloracne
Treatment of the acne variants may include
topical therapy
long courses of tetracycline antibiotics
isotretinoin (vitamin-A derivative)
women = antiandrogenic therapy
The follicular occlusion syndrome refers to:
Hidradenitis suppurativa (acne inversa)
Acne conglobata (a severe form of nodulocystic acne)
Dissecting cellulitis (perifolliculitis capitis abscedens et suffodiens)
