folliculitis
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Introduction
Infection with inflammation of an upper segment of hair follicle.
Etiology
- bacterial
- Staphylococcus aureus (most common)
- Propionibacterium acnes
- Pseudomonas aeruginosa (hot tub folliculitis)
- gram-negative bacilli
- associated with systemic antibiotic therapy of acne vulgaris[5]
- often Escherichia coli[5]
- secondary syphilis
- fungal
- viral
- Demodicidosis (Demodex)
- predisposing factors
- shaving hairy regions
- occlusion of hairy areas facilitates growth of microorganisms
- high temperature & humidity
- topical glucocorticoids
- systemic antibiotics promotes growth of resistant organisms
- diabetes mellitus
- immunosuppression (systemic glucocorticoids)[3]
Epidemiology
- inadequate water chlorination hot tub, whirlpool or less commonly, public swimming pool
- common among athletes[5]
Pathology
* histopathology images[8]
Clinical manifestations
- pruritic eruption
- hair follicle-centered erythematous papules with pustules
- trunk, axilla, buttocks, & proximal extremities most commonly affected (areas with short, coarse hair)[4]
- scalp commonly affected[5]
- Pseudomonas folliculitis begins 1-4 days after bathing (hot tub etc)
Laboratory
- Gram's stain
- KOH preparation for fungal hyphae
- culture of pustule
- concern for MRSA or other drug-resistant organism
- skin biopsy
* diagnosis can be made from clinical presentation[5]
Complications
- pseudomonas folliculitis
Management
- prophylaxis
- adequate chlorination of hot tubs & swimming pools
- general measures
- wash with antibacterial soap, benzoyl peroxide, or chlorhexidine
- Bacterial folliculitis
- Propionibacter acnes (see acne)
- Staphylococcus aureus
- mupirocin ointment BID to involved skin & nares
- dicloxacillin 1-2 g/day divided QID for 10 days
- cephalexin (Keflex) 1-2 g/day divided QID for 10 days
- erythromycin 1-2 g/day divided QID for 10 days
- minocycline 1-2 g/day divided QID for 10 days for MRSA
- Pseudomonas aeruginosa
- in most cases spontaneous resolution within 7-14 days
- ciprofloxacin 500 mg BID if persistent[5]
- ceftazidime or cefepime for severe or prolonged cases or immunosuppressed patients
- gram-negative folliculitis
- discontinue current antibiotics
- topical benzoyl peroxide
- ampicillin 250 mg QID
- Bactrim DS BID
- isotretinoin
- fungal folliculitis
- itraconazole 100 mg BID for 10-14 days (Pityrosporum, Candida)
- terbinafine 200 mg/day (Dermatophytes)
- fluconazole 100 mg BID for 10-14 days (Candida)
- herpetic folliculitis
- acyclovir 400 mg TID for 7 days
- see Herpes simplex
- Demodicidosis (Demodex) - permethrin cream
More general terms
More specific terms
Additional terms
References
- ↑ Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 36-43
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 294
- ↑ 3.0 3.1 Kaplan DL, Dermclinic Consultant Dec 2005, pg 1563 http://www.ConsultantLive.com
- ↑ 4.0 4.1 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021.
- ↑ 6.0 6.1 MedicineNet.com Image Collection: Bacterial Skin Diseases. Picture of Folliculitis http://www.medicinenet.com/image-collection/folliculitis_picture/picture.htm
- ↑ 7.0 7.1 DermNet NZ. Folliculitis (images) http://dermnetnz.org/acne/folliculitis.html
DermNet NZ. Bacterial folliculitis (images) http://dermnetnz.org/bacterial/bacterial-folliculitis.html - ↑ 8.0 8.1 8.2 Satter EK, MD, Elston DM (images) Medscape: Folliculitis http://emedicine.medscape.com/article/1070456-overview
- ↑ Elkston CA, Elkston DM Bacterial Skin Infections: More Than Skin Deep. Medscape. July 19, 2021 https://reference.medscape.com/slideshow/infect-skin-6003449