Folliculitis

Folliculitis

Folliculitis is  a group of skin conditions where there are inflamed hair follicles. The result is a tender red spot, often with a surface pustule.

Folliculitis may be superficial or deep.

 It can affect anywhere there are hairs, including chest, back, buttocks, arms and legs.

 Acne and its variants are also types of folliculitis.

can be due to infection, occlusion (blockage) or irritation

Staphylococcus aureus.and Pseudomonas aeruginosa are two of the most common organisms causing bacterial folliculitis

Pityrosporum ovale, also known as Malassezia. Malassezia folliculitis (Pityrosporum folliculitis) is an itchy acne-like condition usually affecting the upper trunk of young adults. 

Candida albicans can also provoke a folliculitis in skin folds (intertrigo) or in the beard area.

both of these could be secondary to antibiotic use.Stop antibiotics and  use  an anti fungal cream.

Tinea capitis,Microsporum canis and Trichophyton tonsurans are some common fungi causing  folliculitis  requiring  oral anti fungal Rx for a few  months.

Herpes simplex ,Herpes zoster and Molluscum contagiosum are the common viral causes.

Colonization by hair follicle mites (demodex) known as demodicosis.is seen in  immuno suppressed patients.

 Infestation by scabies, often leads to folliculitis, as well as non-follicular papules, vesicles and pustules.

Folliculitis may be caused by hairs regrow after shaving, waxing, electrolysis or plucking. these  pustules are sterile.Irritant folliculitis In the beard area is known as pseudofolliculitis barbae. Irritant folliculitis is also common on the lower legs of women (shaving rash). It is frequently very itchy. Treatment is by stopping hair removal, and not beginning again for about three months after the folliculitis has settled. To prevent reoccurring irritant folliculitis, 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.

Occlusion/ Paraffin-based ointments, moisturizers, 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/ cutting oils,Coal tar 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 moisturizers and topical steroids. Perioral dermatitis is treated with tetracycline antibiotics for six weeks or so.

Folliculitis due to immunosuppression

Eosinophilic folliculitis is a specific type of folliculitis that may arise in some immune suppressed individuals

Folliculitis due to drugs

Folliculitis may be due to drugs, particularly corticosteroids (steroid acne), androgens (male hormones), ACTH, lithium, isoniazid (INH), phenytoin and B-complex vitamins. Protein kinase inhibitors (epidermal growth factor receptor inhibitors) and targeted therapy for metastatic melanoma (vemurafenib, dabrafenib) nearly always result in folliculitis.

Folliculitis due to inflammatory skin diseases

Certain uncommon inflammatory skin diseases may cause permanent hair loss and scarring because of deep seated sterile folliculitis. These include:

Lichen planus/Discoid lupus erythematosus/Folliculitis decalvans/Folliculitis keloidalis

Treatment depends on the underlying condition and its severity. A skin biopsy is often necessary to establish the diagnosis.

Acne variants 

Acne and acne-like or acneform disorders are also forms of folliculitis. These include:

Acne vulgaris/ Nodulocystic acne/ Rosacea/ Scalp folliculitis/ Chloracne

Follicular occlusion syndrome refers to:

Hidradenitis suppurativa (acne inversa)

Acne conglobata (a severe form of nodulocystic acne)

Dissecting cellulitis (perifolliculitis capitis abscedens et suffodiens)

Pilonidal sinus.

Buttock folliculitis

Folliculitis affecting the buttocks is quite common and is often nonspecific, ie no specific cause is found. Buttock folliculitis is equally common in males and females.Acute buttock folliculitis is usually bacterial in origin (like boils), resulting in red painful papules and pustules. It clears with antibiotics.

Chronic buttock folliculitis does not often cause significant symptoms but it can be very persistent. Although antiseptics, topical acne treatments, peeling agents such as alphahydroxy acids, long courses of oral antibiotics and isotretinoin can help buttock folliculitis, they are not always effective. Hair removal might be worth trying if the affected area is hairy. As regrowth of hair can make it worse, permanent hair reduction by laser or intense pulsed light (IPL) is best.