Folliculitis

Folliculitis is the infection and inflammation of one or more hair follicles. The condition may occur anywhere on hair covered skin. The rash may appear as pimples that come to white tips on the face, chest, back, arms, legs, buttocks, or head.[1]

Folliculitis
Folliculitis, single lesion
SpecialtyDermatology

Signs and symptoms
Histopathology of folliculitis of unknown cause, with giant cells surrounding a hair follicle.
  • rash (reddened skin area)
  • itching skin
  • pimples or pustules located around a hair or follicle; may be confused with chicken pox
  • spreading from leg to arm to body through improper treatment with antibiotics
  • Chronic folliculitis surrounding central sebaceous hyperplasia, right mid chest

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,[2] 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
Main article: Fungal folliculitis

Viral
  • Herpetic folliculitis rarer, but may occur when herpes simplex virus infection spreads to nearby hair follicles appearing in groups or clusters,[1] mostly around the mouth.

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.[5]

Complications

Condition can develop into a more severe skin condition such as cellulitis or abscess.[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. Winters RD, Mitchell M (18 September 2019). Folliculitis in StatPearls. PMID 31613534.
  2. "NHS Direct".
  3. MedlinePlus Encyclopedia: Hot tub folliculitis
  4. "Severe Acne: 4 types". American Academy of Dermatology. Archived from the original on February 9, 2011. Retrieved December 15, 2010.
  5. 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.
Classification
External resources
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