| Folliculitis is a superficial or deep infection and inflammation of hair follicles usually arising from blockage of the associated oil (sebaceous) gland. The infection and inflammation may spread to areas around the affected follicles. Folliculitis can be bacterial (most often Staphylococcus), fungal (Candida), or viral (herpes simplex or molluscum contagiosum).
Factors that promote folliculitis include shaving, friction from clothing, athletic padding, mineral oil on the skin, and the use of wax to remove hair (wax epilation). Folliculitis may occur anywhere on the skin surface but is commonly found on the extremities, scalp, and face. It usually occurs in areas with short, coarse hairs. Chronic folliculitis of the bearded area is called barber's itch (sycosis barbae).
Less common causes of folliculitis are the Klebsiella, Proteus, and pseudomonas bacteria. Klebsiella or Proteus can cause folliculitis in individuals on long-term antibiotic treatment for acne. Pseudomonas causes "hot tub" or "spa pool" folliculitis and is contracted by individuals using a contaminated, inadequately chlorinated hot tub. Hot tub folliculitis may also be contracted from swimming pools or a contaminated sponge or loofah.Risk: Folliculitis is more common in people who are immunocompromised, obese, and those with diabetes (Cyr). Additional risk factors include individuals who have pre-existing dermatitis, hyperhidrosis, frequent hot tubs, and shave or wax regularly. Barber's itch is most common in black males. Incidence and Prevalence: Folliculitis is a common skin infection. However, incidence of chronic folliculitis is low. |
Source: Medical Disability Advisor
| History: The individual with folliculitis complains of pus-filled pimples (pustules) associated with hair follicles. The individual may complain of pain and itching (pruritus) in the affected area. Individuals with widespread folliculitis may report recent use of a hot tub. Individuals with hot tub folliculitis may also complain of headache, low-grade fever, sore throat, sore eyes, dizziness, and a feeling of discomfort and fatigue (malaise). Physical exam: Diagnosis is made based on the clinical appearance of small, dome-shaped, yellowish pustules occurring at the opening of a hair follicle, often on the scalp or in the beard area. Folliculitis restricted to the trunk, legs, and arms suggests hot tub folliculitis. Tests: A culture of the pus may be taken to identify the causative agent, especially in deep and chronic cases. Skin samples (biopsy) may be taken to diagnose a possible viral infection in individuals with folliculitis that fails to respond to standard antibiotic or antifungal treatment. |
Source: Medical Disability Advisor
| Treatment with warm saline compresses and application of local (topical) antibiotics or antifungals is usually sufficient to control bacterial or fungal infection, respectively. Folliculitis of the scalp is treated with selenium sulfide shampoo and antibiotic and corticosteroid creams. Viral folliculitis may be treated with antiviral agents or by scraping (curettage). Individuals with extensive folliculitis require oral antibiotic therapy. Individuals should stop shaving the affected area until the folliculitis clears. Switching from a blade to an electric razor may be beneficial. Razor blades should be changed and the heads of electric razors decontaminated daily to prevent reinfection. |
Source: Medical Disability Advisor
| The outcome is good with complete resolution usually occurring within 10 days. Folliculitis generally resolves without scarring except in deep follicles or complicated cases. Folliculitis may be chronic in areas with multiple, deep follicles (bearded area). Recurrence is possible. |
Source: Medical Disability Advisor
| Complications include boils (furunculosis), clusters of boils (carbuncles), aggregations of immune cells (granulomas), ulcerations, subcutaneous abscesses, chronicity, neurodermatitis, and scarring. Chronic, deep folliculitis of the scalp (folliculitis decalvans) can cause hair loss (alopecia). Inadequate treatment can cause folliculitis to spread to deeper levels of the skin and can cause scarring. |
Source: Medical Disability Advisor
| Contact with oils and greases should be avoided. Individuals should practice ordinary hygienic measures that include daily showers, changes of clothing, and keeping nails short and clean. Clothing should be loose to minimize sweating and irritation. The use of personal protective equipment (respirator) may be affected depending on the location of the folliculitis. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does the individual have a recent history of hot tub use?
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Does the individual regularly shave and/or wax?
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Are the skin symptoms isolated to the trunk and extremities?
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Has the individual been on long-term antibiotic use for acne?
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Have cultures of the pus been performed?
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Has the individual been tested to determine if they are a carrier of Staphylococcus aureus?
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Has a skin biopsy been performed?
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Has blood work been done or other tests performed to diagnose a potential underlying condition (i.e., immune suppression)?
Regarding treatment:
- Is the appropriate antibiotic being used for the specific type of bacteria?
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Is the individual complying with treatment recommendations?
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Does the folliculitis recur in the shaved areas of skin? Has the individual been instructed to use an electric razor?
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Is the individual being treated with oral antibiotics?
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If obese, has the individual been consulted about diet?
Regarding prognosis:
- Have the symptoms persisted despite treatment?
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Was a repeat culture and sensitivity done to rule out secondary infection or a antibiotic resistant bacteria?
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Have appropriate adjustments in antibiotic therapy been made?
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Does the individual have any underlying conditions such as diabetes, acne vulgaris, AIDS, organ transplantation, cancer, obesity, and diseases causing impaired circulation (e.g., arteriosclerosis), that may impact recovery and prognosis?
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Has the individual experienced any complications (boils, granulomas, ulcerations, subcutaneous abscesses, chronicity, neurodermatitis, or scarring) that may impact recovery and prognosis?
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Source: Medical Disability Advisor
| Cyr, Peggy R. "Folliculitis." eMedicine. Eds. Daniel Hogan, et al. 5 Nov. 2000. Medscape. 12 Oct. 2004 <http://emedicine.com/derm/topic159.htm>. |
Source: Medical Disability Advisor
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