Folliculitis: Short Note
- Folliculitis is the inflammation or infection of the hair follicles
- Commonly caused by bacterial or fungal infections.
- It presents as small, red, and sometimes pus-filled bumps around hair follicles.
Aetiology
- Bacterial: Staphylococcus aureus is the most common pathogen.
- Fungal: Malassezia and dermatophytes can also cause folliculitis.
- Viral: Herpes simplex virus (HSV) can sometimes cause folliculitis around the lips or genital area.
Clinical Features
- Small, red, inflamed bumps around hair follicles, often with pus.
- Commonly affects areas like the scalp, face, armpits, and groin.
- Pruritus (itchiness) and tenderness are common.
- In more severe cases, pustules and abscesses can form.
Diagnosis
- Clinical examination based on the appearance of lesions.
- Culture of pustules or swabs to identify the causative organism.
- Skin biopsy in recurrent or chronic cases.
Types of Folliculitis
| Type | Description | Common Causes | Treatment |
|---|---|---|---|
| Bacterial Folliculitis | Superficial infection of hair follicles, presenting as red, inflamed pustules. | Staphylococcus aureus is the most common pathogen. | Topical or oral antibiotics (e.g., mupirocin, dicloxacillin) depending on severity. |
| Pseudomonas Folliculitis (Hot Tub Folliculitis) | Occurs after exposure to contaminated water, leading to itchy, red pustules. | Pseudomonas aeruginosa infection from poorly maintained hot tubs or pools. | Usually self-limiting; oral fluoroquinolones for persistent or severe cases. |
| Pityrosporum Folliculitis | Chronic, itchy folliculitis often on the back, chest, or shoulders. | Overgrowth of Malassezia (a yeast). | Topical antifungals (e.g., ketoconazole); oral antifungals for widespread infection. |
| Viral Folliculitis | Folliculitis caused by viruses, most commonly herpes simplex virus (HSV). | Reactivation of HSV or direct inoculation. | Oral antiviral agents such as acyclovir or valacyclovir. |
| Gram-negative Folliculitis | Occurs in patients on long-term antibiotic therapy for acne, leading to overgrowth of gram-negative bacteria. | Caused by bacteria like Proteus, Klebsiella, or Enterobacter. | Discontinue antibiotics, consider isotretinoin or appropriate antimicrobial therapy. |
Clinical Features
- Small, red papules or pustules around hair follicles
- Pruritus or mild pain in the affected area
- Pustules may break open, forming crusts
- Commonly affected areas: scalp, beard area (barber’s itch), chest, back, and buttocks
- Possible systemic symptoms in severe or widespread infections (e.g., fever)
Diagnosis
- Clinical Examination: Typical appearance of pustules and inflammation around hair follicles.
- Bacterial Cultures: Swabbing for culture and sensitivity if infection is suspected or recurrent.
- KOH Test: For suspected fungal folliculitis (e.g., Pityrosporum folliculitis).
- Skin Biopsy: May be required for deeper or non-resolving folliculitis to rule out other causes (e.g., folliculitis decalvans).
Treatment and Management
- Topical Therapy: Topical antibiotics (e.g., mupirocin, clindamycin) or antiseptics (e.g., benzoyl peroxide) for mild cases.
- Oral Antibiotics: For moderate to severe bacterial folliculitis or cases that are widespread.
- Antifungals: Topical or oral antifungal agents for fungal causes (e.g., Pityrosporum folliculitis).
- Antivirals: Oral antivirals for viral folliculitis, such as herpes-associated cases.
- Hygiene and Prevention: Regular cleaning of the skin, avoiding tight clothing, and maintaining proper hygiene in settings like gyms or hot tubs.
Note: Chronic or recurrent folliculitis may require long-term therapy and lifestyle modifications. Consider referral to a dermatologist for severe, treatment-resistant cases.