Localized inflammation of a hair follicle. The condition may be caused by infections, injury or irritation and is generally found on the face, neck, breast and buttocks.The damaged follicles are then infected with the bacteria Staphylococcus (staph).
Lymphedema patients are more susceptible to skin infections and are strongly advised against hot tubs because of the possibility of contracting Pseudomona folliculitis. This is a resistant gram-negative bacterial infection with serious complications.
Pseudofolliculitis barbae is a disorder that occurs mainly in black men. If curly beard hairs are cut too short, they may curve back into the skin and cause inflammation.(1)
Pus in the hair follicle
Irritated and red follicles
Damaged hair (possibly in growing back into the follicle)
While we tend to think of folliculitis as a minor and superficial infection, it is important to remember that with a lymphedema limb that is immunocompromised, the folliculitis could develop into a more severe infection. Complications include cellulitis, forunculosis (This condition occurs when a number of boils develop under your skin. Boils usually start as small red bumps but become larger and more painful as they fill with pus), scarring, destruction of the hair follicle. Untreated and/or severe/deep folliculitis could result in sepsis and bacteremia.
Topical antibiotics which may include bacitracin, polymyxin B sulfate (Polysporin), clindamycin, erythromycin, or mupirocin (Bactroban). You may also use an antiseptic cleanser, such as povidone-iodine (for example, Betadine) or chlorhexidine.
Oral antibiotics based on the seriousness (deeper or more severe infections) of the folliculitis or on the underlying medical condition of the patient. If caused by a bacteria, your doctor may prescribe dicloxacillin, erythromycin, or cephalexin (such as Keflex). Ciprofloxacin (Cipro) and ofloxacin (such as Floxin) are used for certain types of bacteria.
Fungus based folliculitis is treated with antifungal oral medications which include You will need to take antifungal pills, such as fluconazole (Diflucan), griseofulvin (Fulvicin-U/F or Gris-PEG, for example), itraconazole (Sporanox), or terbinafine (Lamisil).
(1) PubMed Health
With common names like hot tub folliculitis and barber's itch, folliculitis may sound more like a bad joke than a skin disorder. But folliculitis, an infection of the hair follicles, is no laughing matter. Severe cases may cause permanent hair loss and scarring, and even mild folliculitis can be uncomfortable and embarrassing.
Folliculitis usually appears as small, white-headed pimples around one or more hair follicles — the tiny pockets from which each hair grows. Most infections are superficial, and they may itch, but on occasion they're painful. Superficial folliculitis often clears by itself in a few days, but deep or recurring folliculitis may need medical treatment.
The signs and symptoms of folliculitis vary, depending on the type of infection. In forms of the disorder that affect the upper part of the hair follicle (superficial folliculitis), signs and symptoms include:
Deep folliculitis starts deeper in the skin surrounding the hair follicle and affects the entire hair follicle. Signs and symptoms of deep folliculitis include:
Superficial forms of folliculitis include:
Types of deep folliculitis include:
Every hair on your body grows from a follicle, a small pocket of modified skin. Although follicles are densest on your scalp, they occur everywhere except your palms, soles and mucous membranes, such as your lips.
Each follicle is attached to a small muscle. When you're cold or frightened, the muscle contracts, raising the hairs above the level of your skin and giving the appearance of goose bumps. Just above these muscles are sebaceous glands that produce an oil (sebum) that lubricates your skin and coats each hair shaft. Sebum is carried to the follicles and skin in tiny ducts.
Normally, the follicles carry out these functions with few problems. But when they're damaged, they may be invaded by viruses, bacteria or fungi, leading to infections such as folliculitis.
The most common causes of hair follicle damage include:
Anyone can develop folliculitis, but certain factors make you more susceptible to the condition. These include:
Mild cases of folliculitis often clear up without any treatment. But if the infection doesn't improve in two or three days, appears to spread or recurs often, call your doctor or a dermatologist. You may need antibiotics or antifungal medications to help control the problem.
Your doctor is likely to diagnose folliculitis simply by looking at your skin. When standard treatments fail to clear the infection, your doctor may send a sample taken from one of your pustules to a laboratory, where it's grown on a special medium (cultured) and then checked for the presence of bacteria. When doctors suspect eosinophilic folliculitis, they may remove a small tissue sample (biopsy) from an active lesion for testing.
Mild cases of folliculitis aren't likely to cause complications, although the infection may recur or spread, leading to large, itchy patches of staph infection on the skin (plaques).
Complications of severe folliculitis may include:
For some, folliculitis goes away without medical treatment within two to three days. During that time, self-care measures, such as warm compresses and anti-itch creams, can help relieve your symptoms.
Persistent or recurring cases are likely to require treatment. The therapy your doctor recommends will depend on the type and severity of your infection.
Although it's not always possible to prevent folliculitis, these measures may help keep you infection-free:
Mild cases of folliculitis often respond well to home care. The following suggestions may help relieve discomfort, speed healing and prevent the infection from spreading:
October 05, 2007
Hot tub folliculitisFolliculitis is a superficial infection of the hair follicle. Hot tub folliculitis is a folliculitis that develops after exposure to certain forms of bacteria that reside in warm, wet environments such as hot tubs.
Causes, incidence, and risk factors
Most folliculitis is caused by the common organism Staphylococcus aureus. Hot tub folliculitis is different in that it is caused by Pseudomonas aeruginosa. Pseudomonas survives in hot tubs, especially hot tubs made of wood, unless the pH and chlorine content are strictly controlled.
Hot tub folliculitis becomes noticeable within half a day to two days after exposure. It first appears as itchy bumps, some of which may be filled with pus. It may then develop into dark red tender nodules. The rash may be more dense under swimsuit areas, where the material has held the contaminated water in contact with the skin for a longer period of time.
Signs and testsPhysical examination combined with a history of recent hot tub use are sufficient for your health care provider to make this diagnosis. Testing is usually unnecessary.
Treatment may not be needed, as the mild form of the disease usually clears on its own. Oral or topical anti-pruritics ("anti-itch" medications) may be used.
In severe cases, your physician may prescribe an oral antibiotic such as ciprofloxacin.
This condition usually clears without scarring. It may recur if the infected hot tub is not cleaned.
Calling your health care providerCall your health care provider if you develop symptoms of hot tub folliculitis.
PreventionCareful attention to controlling the pH and chlorine content of the hot tub may help to prevent hot tub folliculitis.
Update Date: 1/11/2003
Pityrosporum folliculitis is a condition where the yeast, pityrosporum ovale/orbicularis spp. (also called Malassezia furfur), gets down into the hair follicles and multiplies, setting up an itchy, acne-like eruption.
Pityrosporum folliculitis is not an infection as such, it is an overgrowth of what is normally there. The yeast overgrowth may be encouraged by external factors and/or by reduced resistance on the part of the host. The reasons why a particular patient develops pityrosporum folliculitis are not fully understood but the following are believed to be important:
The rash consists of tiny itchy dome-shaped pink papules with an intermingling of small pustules. The spots are located mainly on the upper back, shoulders and chest. Sometimes spots are found on the forearms, back of the hands, lower legs and face. The tendency to scratch spots is greatest on the forearms, face and scalp. Most patients have oily skins.
Most patients seek advice because of the itch. This may have lead their doctors to suspect scabies or other mite infestations. The itch tends to come in episodes, accompanied by a stinging sensation. Some patients notice the itch is worse after sweat-inducing exercise or after a hot shower. When scratched, the spots may display a local hive-like reaction with a surrounding red flare.
Patients may also have pityriasis versicolor, a condition where light brown and pale, itchy patches appear on the trunk; or seborrhoeic dermatitis, where a red scaly rash appears in the scalp ("dandruff"), behind the ears, eyebrows, sides and angles of the nose, cheek folds, moustache area, chin, armpits, chest and sometimes the groins and buttock cleft. In these conditions an overgrowth of the same pityrosporum yeast is believed to be involved.
Patients may also have true acne accompanying the pityrosporum folliculitis. This is not surprising because increased skin oil also encourages acne but in this case there is an overgrowth of the normal skin bacteria rather than yeasts.
If you have pityrosporum folliculitis, see your doctor or dermatologist for advice.
Treatment must deal with both the yeast overgrowth and any predisposing factors, otherwise the condition will recur. Unfortunately we often either do not know, or cannot correct, all the factors which make one susceptible so the condition has a tendency to return once the anti-yeast treatment is stopped.
The first step in management is to correct as far as possible any of the predisposing factors listed above. Specific treatment can be divided into:
On other websites:
Pityrosporum folliculitis: from emedicine dermatology, the online textbook
Folliculitis decalvans is a form of alopecia (hair loss) that involves scarring. It is characterised by redness and swelling and pustules around the hair follicle (folliculitis) that leads to destruction of the follicle and consequent permanent hair loss. Folliculitis decalvans is one cause of cicatricial alopecia (baldness with scarring) and is sometimes known as tufted folliculitis.
Folliculitis decalvans affects both men and women and may start first during adolescence or at any time in adult life. The exact cause is unknown. In most cases Staphylococcus aureus can be isolated from the pustules but the role of the bacteria is not clear.
What are the signs and symptoms?
Any hairy region may be involved. It is usually confined to the scalp but can involve other sites including the beard, underarm and pubic hair, lower legs, thighs and arms. There are usually round or oval patches of hair loss in which there are pustules surrounding the hair follicles (perifollicular pustules). Characteristically, several or many hairs can be seen coming out of a single follicle, so the scalp looks "tufted" like a toothbrush. Eventually the hairs are shed as the follicle is completely destroyed and leaves behind a scar.
Usually there are no symptoms but sometimes the affected area may be itchy. The disease may remain limited to a few small patches or may progress over time causing extensive hair loss.
What is the treatment of folliculitis decalvans?
There is no permanent cure for the condition but it can be controlled to some degree by using medications.
Abstracts and Studies
A possible new cause of spa bath folliculitis: Aeromonas hydrophila.
Australas J Dermatol. 2008 Feb
Department of Dermatology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia. firstname.lastname@example.org
A 34-year-old man presented with a pubic eruption of 4 weeks duration, affecting both himself and his partner. He had been treated unsuccessfully with intravenous and oral dicloxacillin. The eruption was a severely inflammatory folliculitis, with haemo-serous exudate and marked oedema. A clinical diagnosis of herpes simplex virus folliculitis was disproved when routine bacteriology isolated Aeromonas hydrophila and multiple viral polymerase chain reaction studies were negative. Histology demonstrated a chronic folliculitis with no organisms present. Both he and his partner were treated with oral ciprofloxacin 500 mg bd for 6 weeks with clinical clearance of infection, but both developed a scarring alopecia. Infection was attributed to possible contamination of a poorly maintained home spa bath with A. hydrophila.
Malassezia folliculitis: characteristics and therapeutic response in 26 patients
Ann Dermatol Venereol. 2007 Nov
Service de Dermatologie I, Hôpital Saint-Louis, Paris.
BACKGROUND: Malassezia folliculitis is most often described in patients living in hot and humid countries or in immunocompromised patients. Its frequency in France is unknown. We report 26 cases diagnosed at Saint-Louis Hospital between May 2002 and April 2004. The clinical features, the contributing factors, the results of direct mycological examination and/or histology and the efficacy of antifungal treatments were compared to the literature.
PATIENTS AND METHODS: The inclusion criteria were the presence of folliculitis on the trunk confirmed by direct microscopy and/or histopathology showing abundant yeast cells in the follicles.
RESULTS: Patients comprised 22 men and 4 women (M/F sex ratio: 5: 5) with a mean age of 46 years. Five patients (19%) were immunocompromised. In normal patients, the duration of folliculitis was long with a mean of 61 months. The eruption was typical, with follicular papules and superficial pustules distributed predominantly on the trunk. Itching was frequent (70%). Direct microscopy was more often positive than histology (89% vs 33%). Some sixty-five percent of the patients had been previously treated by topical or systemic antibiotics or anti-acne drugs, which was ineffective in all cases. Cure with topical ketoconazole, oral ketoconazole alone or in combination with topical ketoconazole occurred respectively in 12%, 75% and 75% of patients, but with consistent recurrence within 3 to 4 months after cessation of treatment.
DISCUSSION: Malassezia folliculitis is probably misdiagnosed, as suggested by the long time between onset and diagnosis and the high frequency of non-antifungal treatments prescribed. In our study, direct mycological examination provided more effective diagnosis than histology. Treatment is difficult especially because of the high frequency of relapses.
CONCLUSION: A diagnosis of Malassezia folliculitis should be considered in young adults or immunocompromised patients with an itching follicular eruption. Further therapeutic trials are needed due to the frequency of relapse.
Eosinophilic pustular folliculitis.
Classical eosinophilic pustular folliculitis, or Ofuji's disease, is a chronic and relapsing dermatosis that is predominantly reported in East Asian populations. Clinically, the disease typically begins as small papules, which enlarge and coalesce into a large plaque, usually on the face. The histopathology is characterized by a prominent eosinophilic infiltrate in the dermis with concentration around pilosebaceous units, often with eosinophilic microabscess formation. The differentiation of eosinophilic pustular folliculitis from other eosinophilic dermatoses is practically challenging and requires close clinicopathologic correlation. Eosinophilic pustular folliculitis may also be associated with human immunodeficiency virus infection, various drugs, and some lymphomas and could also be thought of as a nonspecific dermatopathologic pattern in such settings. The cause of classical eosinophilic pustular folliculitis is unknown, although immune processes are almost certain to play a key role in its pathogenesis.
Hot tub folliculitis or hot hand-foot syndrome caused by Pseudomonas aeruginosa
J Am Acad Dermatol. 2007 Oct
Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
Pseudomonas aeruginosa is a ubiquitous gram-negative rod that can cause a well-recognized, acquired skin infection from bacterial colonization of contaminated water called "hot tub folliculitis." We report an outbreak of pseudomonas skin infection associated with the use of a hot tub at a pool party in 33 children. In particular, 2 of the children were admitted to our hospital; both presented with high leukocyte counts, intermittent low grade fevers, and painful, erythematous nodules and papules on their palms and soles. One of the 2 children also presented with small erythematous pustular lesions on the face and trunk, which led to the diagnosis. Cultures from these pustules grew P aeruginosa. Thirty two other children at this pool/hot tub party developed similar lesions of varying severity 6 to 48 hours after the party. These findings were most consistent with the diagnosis of pseudomonas folliculitis/hot hand.
Traction folliculitis: an underreported entity.
Cutis. 2007 Jan
Medical University of Ohio, Toledo, USA. email@example.com
Traction folliculitis is a component of traction alopecia syndrome and has received minimal attention in primary source medical literature. The popularity of hairstyles that produce hair traction and the knowledge that early intervention improves prognosis amplify the importance of recognizing this entity. Traction folliculitis presents as perifollicular erythema and pustules on the scalp in areas where hairstyles produce traction on the hair shaft. In addition to the traction, concurrent hair care practices may play a facilitatory role in the development of traction folliculitis. Treatment involves immediate removal of traction on hair and temporary alteration of the facilitatory hair care practices. In more severe cases, topical or systemic antibacterial therapy and, occasionally, topical corticosteroid therapy may be necessary. Failure to discontinue traction-producing hairstyles can lead to traction alopecia and irreversible hair loss. Cultural considerations often are paramount in hairstyle choices and hair care practices that cause predisposition to traction disorders. Thus, culturally competent counseling requires understanding the significance of the hairstyle and hair care practices to the patient (or caregivers), discussing the recommendations in a culturally sensitive manner, and negotiating mutually acceptable alternative practices.
PMID: 17330618 [PubMed - indexed for MEDLINE]
Eosinophilic folliculitis in a Caucasian patient: association with toxocariasis?
J Eur Acad Dermatol Venereol. 2006 Nov
Department of Dermatology and Venereology, University of Würzburg, Würzburg, Germany.
Sterile eosinophilic folliculitis, a clinical entity first described by Ofuji in 1970, is a rather rare skin disorder, in particular in the non-Asian population. We report the first case of eosinophilic folliculitis associated with toxocariasis in a Caucasian patient. Topical and systemic anti-inflammatory and antiphlogistic therapy along with systemic antihelminthic treatment resulted in complete remission of the skin lesions. In addition, there was a marked decrease of antibodies to Toxocara antigens in the patient's serum following antihelminthic therapy. Given that (I) some cases of eosinophilic folliculitis have been reported which were associated with infestation with metazoan parasites; (2) infestations with the roundworm Toxocara canis are known to induce eosinophilic reactions in some tissues; and (3) therapy-induced remission of eosinophilic folliculitis was accompanied by a decrease of Toxocara-directed antibodies in the patient's serum, we propose that there is an aetiopathogenic link between toxocariasis and eosinophilic folliculitis in this patient.
Industrial Pseudomonas folliculitis.
Am J Ind Med. 2006 Nov
Center for Toxicology and Environmental Health (CTEH), Little Rock, Arkansas 72201, USA. firstname.lastname@example.org
Complaints of poor
water quality and skin rashes among workers at a US cardboard
facility were investigated to determine potential causes.
METHODS: Employees were interviewed regarding work duties and health symptoms. Areas of dermatitis in affected employees were visually examined. Collected water samples were tested for potential chemical and microbial contaminants.
RESULTS: A total of 27 employees were identified with complaints of recent skin rashes affecting primarily the upper and lower extremities. Dermatitis complaints were associated with water contact and work in areas with poor water quality. Water testing showed high levels of Pseudomonas aeruginosa. Other tested substances were not at levels of concern.
CONCLUSIONS: Overgrowth of P. aeruginosa occurred in the water system shortly after the facility switched to a closed-loop water recycling system and was the most likely cause of the observed dermatitis. To our knowledge, this is the first reported outbreak of Pseudomonas folliculitis in an industrial setting. Copyright (c) 2006 Wiley-Liss, Inc
The International Society of Dermatology.
DermNet NZ Folliculitis
Folliculitis is the name given to a group of skin conditions in which there are inflamed hair follicles.
Diagnostic Codes and Resources
Follicular disorder, unspecified
2008 ICD-9-CM Diagnosis 704.8
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