- Common skin condition involving inflammation of the hair follicle
- Most frequent symptom is pruritus.
- Painless or tender pustules, vesicles, or pink/red papulopustules up to 5 mm in size
- Most commonly infectious in etiology:
- Staphylococcus aureus bacteria
- Pseudomonas aeruginosa infects areas of the body exposed to poorly sanitized hot tubs, pools, or contaminated water.
- Fungal (dermatophytic, Pityrosporum, Candida)
- Viral (VZV, herpes simplex virus [HSV])
- Parasitic (Demodex mites, schistosomes)
- Noninfectious types
- Acneiform folliculitis
- Actinic superficial folliculitis
- Acne vulgaris
- Keloidal folliculitis
- Folliculitis decalvans
- Perioral dermatitis
- Fox-Fordyce disease
- Pruritus folliculitis of pregnancy
- Toxic erythema of the newborn
- Eosinophilic folliculitis (seen in HIV positive/immunocompromised)
- Follicular mucinosis
- Skin disorders that may produce a follicular eruption:
- Pseudofolliculitis barbae: similar in appearance; occurs after shaving; commonly known as razor bumps, occurs more frequently in black men
- Atopic dermatitis
- Follicular psoriasis
Affects persons of all ages, gender, and race; those who shave or have chronic conditions such as diabetes or those who are immunocompromised are at increased risk.
Superficial folliculitis is most commonly a self-limited condition; therefore, the exact incidence is not known.
Folliculitis is a relatively common skin condition; prevalence rate in the United States is 8 per 1,000.
Etiology and Pathophysiology
Predisposing factors to folliculitis
- Chronic staphylococcal carrier
- Diabetes mellitus
- Pruritic skin disease (e.g., scabies, eczema)
- Exposure to poorly chlorinated swimming pools/hot tubs
- Occlusive corticosteroid use (for multiple hours)
- Most frequently due to S. aureus (increasing number of methicillin-resistant S. aureus [MRSA] cases)
- Also due to Streptococcus species, Pseudomonas (following exposure to water contaminated with the species), or Proteus
- May progress to furuncle and carbuncle
- Dermatophytic (tinea capitis, tinea corporis, tinea pedis)
- Pityrosporum (Pityrosporum orbiculare) commonly affecting teenagers and men, predominantly on upper chest and back
- Molluscum contagiosum
- Demodex mites (commonly Demodex folliculorum), common around nasolabial area
- Schistosomes (swimmer’s itch)
- Acneiform type commonly drug induced (systemic and topical corticosteroids, lithium, isoniazid, rifampin), EGFR inhibitors
- Severe vitamin C deficiency
- Actinic superficial type occurs within 24 to 48 hours of exposure to the sun, resulting in multiple follicular pustules on the shoulders, trunk, and arms.
- Acne vulgaris
- Keloidal folliculitis is a chronic condition affecting mostly black patients; involves the neck and occipital scalp, resulting in hypertrophic scars and hair loss; usually consequence of uncontrolled folliculitis barbae
- Folliculitis decalvans is a chronic folliculitis that leads to progressive scarring and alopecia of the scalp.
- Rosacea consists of papules, pustules, and/or telangiectasias of the face; individuals are genetically predisposed; can be confused with folliculitis
- Fox-Fordyce disease affects the skin containing apocrine sweat glands (i.e., axillae), resulting in follicular papules.
- Eosinophilic pustular folliculitis has three variants: classic (Ofuji disease), associated with HIV infection, and infantile.
- Toxic erythema of the newborn is a self-limiting pustular eruption usually appearing during the first 3 to 4 days of life and subsequently fading in the following 2 weeks.
- Malassezia infections
No known genetic predisposition
- Hair removal (shaving, plucking, waxing, epilating agents)
- Other pruritic skin conditions: eczema, scabies
- Occlusive dressing or clothing
- Personal carrier or contact with MRSA-infected persons
- Diabetes mellitus
- Immunosuppression (medications, chemotherapy, HIV)
- Use of hot tubs or saunas
- Use of EGFR inhibitors
- Chronic antibiotic use (gram-negative folliculitis)
- Tattoo recipient
- Good hygiene practices
- Wash hands frequently with antimicrobial soap.
- Wash towels, clothes, and linens frequently with hot water to avoid reinfection.
- Good hair removal practices
- Exfoliate beforehand.
- Use witch hazel, alcohol, or Tend Skin afterward.
- Shave in direction of hair growth; use shaving gel and moisturizer.
- Decrease frequency of shaving.
- Use clippers primarily or single-blade razors if straight shaving is desired.
Commonly Associated Conditions
Impetigo, scabies, acne, follicular psoriasis, eczema, xerosis, Staphylococcus/MRSA colonization
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