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Folliculitis

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 condition may be caused by staph aureus,  yeast or fungi.  If the condition spreads or becomes persistent swab cultures may need to be taken.

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.

Clinical:

Pus in the hair follicle

Irritated and red follicles

Damaged hair (possibly in growing back into the follicle)

Complications:

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.

Treatment:

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).

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From MayoClinic.com
Special to CNN.com

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:

• Clusters of small red bumps that develop around hair follicles
• Pus-filled blisters that break open and crust over
• Itchiness or tenderness

Deep folliculitis starts deeper in the skin surrounding the hair follicle and affects the entire hair follicle. Signs and symptoms of deep folliculitis include:

• A large swollen bump or mass
• Pus-filled blisters that break open and crust over
• Pain
• Possible scars once the infection clears

Superficial folliculitis
Superficial forms of folliculitis include:

• Staphylococcal folliculitis. This common type of folliculitis is marked by itchy, white, pus-filled bumps that can occur anywhere on your body. When it affects the beard area of men, it's called barber's itch. It occurs when hair follicles become infected with Staphylococcus aureus (staph) bacteria. Although staph bacteria live on your skin all the time, they generally cause problems only when they enter your body through a cut or other wound. This can occur through shaving or with an injury to the skin.
• Pseudomonas folliculitis (hot tub folliculitis). The pseudomonas bacteria that cause this form of folliculitis thrive in a wide range of environments, including hot tubs whose chlorine and pH levels aren't well regulated. Within eight hours to five days of exposure to the bacteria, a rash of red, round, itchy bumps will appear that later may develop into small pus-filled blisters (pustules). The rash is likely to be worse in areas where your swimsuit holds contaminated water against your skin. You're at increased risk of infection if you have diabetes, a history of skin infections, or open cuts or sores.
• Tinea barbae. Caused by a fungus rather than a bacterium, this type of folliculitis develops in the beard area in men, causing itchy, white bumps. The surrounding skin also may become reddened. A more serious, inflammatory form of the infection appears as pus-filled nodules that eventually form a crust and that may occur along with swollen lymph nodes and fever.
• Pseudofolliculitis barbae. An inflammation of the hair follicles in the beard area, pseudofolliculitis barbae affects men with curly beards. It develops when shaved hairs curve back into the skin, leading to inflammation and, in rare cases, to dark raised scars (keloid scars) on the face and neck.
• Pityrosporum folliculitis. Especially common in young and middle-aged adults, pityrosporum folliculitis produces chronic, red, itchy pustules on the back and chest and sometimes on the neck, shoulders, upper arms and face. It's caused by the yeast-like fungus.
• Herpetic folliculitis. Shaving through a cold sore — a small, fluid-filled blister caused by the herpes simplex virus — can sometimes spread the herpes infection to neighboring hair follicles.

Deep folliculitis
Types of deep folliculitis include:

• Gram-negative folliculitis. This sometimes develops in people receiving long-term antibiotic treatment for acne. Antibiotics alter the normal balance of bacteria in the nose, leading to an overgrowth of harmful organisms (gram-negative bacteria). In most people, this doesn't cause problems, and the flora in the nose returns to normal once antibiotics are stopped. In a few people, however, gram-negative bacteria spread to the cheeks, chin and jaw line, where they cause new, sometimes-severe acne lesions.
• Boils and carbuncles. These occur when hair follicles become deeply infected with staph bacteria. A boil usually appears suddenly as a painful pink or red bump about 1/2 inch in diameter. The surrounding skin also may be red and swollen. Within 24 hours, the bump fills with pus. It grows larger and more painful for five to seven days, sometimes reaching golf ball size before it develops a yellow-white tip that finally ruptures and drains. Boils generally clear completely in about two weeks. Small boils usually heal without scarring, but a large boil may leave a scar. A carbuncle is a cluster of boils that often occurs on the back of the neck, shoulders or thighs, especially in older men. Carbuncles cause a deeper and more severe infection than does a single boil. As a result, they develop and heal more slowly and are likely to leave scars.
• Eosinophilic folliculitis. Seen primarily in HIV-positive people, this type of folliculitis is characterized by recurring patches of inflamed, pus-filled sores, primarily on the face and sometimes on the back or upper arms. The sores usually spread, may itch intensely and often leave areas of darker than normal skin (hyperpigmentation) when they heal. The exact cause of eosinophilic folliculitis isn't known, although it may involve the same yeast-like fungus responsible for pityrosporum folliculitis.

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:

• Friction from shaving or tight clothing
• Excessive perspiration
• Inflammatory skin conditions, including dermatitis and acne
• Injuries to your skin, such as abrasions or surgical wounds
• Covering your skin with plastic dressings or adhesive tape
• Exposure to coal tar, pitch or creosote — common among roofers, mechanics and oil workers

Anyone can develop folliculitis, but certain factors make you more susceptible to the condition. These include:

• Medical conditions that reduce your resistance to infection, such as diabetes, chronic leukemia, organ transplantation and HIV/AIDS
• A pre-existing skin condition, such as acne or dermatitis
• Trauma to your skin from surgery
• Long-term antibiotic therapy for acne
• Topical corticosteroid therapy
• Obesity — folliculitis is more common in people who are overweight
• Living in a warm, humid climate

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:

• Cellulitis. This potentially serious bacterial infection appears as a swollen, red area of skin that feels hot and tender and that may spread rapidly. It's most common on your legs, arms or face. Although the initial infection may be superficial, it eventually can affect the tissues underlying your skin or spread to your lymph nodes and bloodstream.
• Furunculosis. 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. Severe folliculitis may leave thick, raised scars (hypertrophic or keloid scars) or patches of skin that are darker than normal.
• Destruction of the hair follicle. This leads to permanent hair loss.

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.

• Staphylococcal folliculitis. Your doctor may prescribe an antibiotic that you apply to your skin (topical) or that you take by mouth (oral). Your doctor may also recommend that you avoid shaving the affected area until the infection heals. If you must shave, use an electric razor or clean razor blade every time.
• Pseudomonas folliculitis (hot tub folliculitis). Hot tub folliculitis rarely requires specific treatment, although your doctor may prescribe an oral or topical medication to help relieve itching (anti-pruritic). More serious cases may require an oral antibiotic.
• Tinea barbae. This infection — especially the inflammatory form — can be effectively treated with oral antifungal medications.
• Pseudofolliculitis barbae. Self-care measures are the best treatments for this condition. Shaving with an electric razor, which doesn't cut as closely as a razor blade does, can help. If you do use a blade, massage your beard area with a warm, moist washcloth or facial sponge to lift the hairs so that they can be cut more easily. Use a shaving gel instead of cream, and shave in the direction of the hair growth. When you're finished, rinse thoroughly with warm water and apply a moisturizing after-shave. If these measures don't help, your doctor may prescribe the acne medication tretinoin (Retin-A).
• Pityrosporum folliculitis. Topical or oral antifungals are the most effective treatments for this type of folliculitis. Because the condition often returns once you've finished the course of oral medication, your doctor may recommend using topical ointments indefinitely. Antibiotics aren't helpful in treating pityrosporum folliculitis and may make the infection worse by upsetting the normal balance of bacteria on your skin.
• Herpetic folliculitis. If you're a healthy adult, herpetic folliculitis may clear without treatment in seven to 10 days. But if you're living with HIV/AIDS or you experience frequent cold sores, your doctor may prescribe an oral antiviral medication such as acyclovir, famciclovir or valacyclovir. Although these drugs can clear the infection, they won't necessarily prevent it from recurring. They also may cause side effects such as headache, diarrhea, nausea and abdominal pain.
• Gram-negative folliculitis. Although this type of folliculitis results from long-term antibiotic therapy for acne, it's usually treated with certain antibiotics or with isotretinoin (Accutane).
• Boils and carbuncles. Your doctor may drain a large boil or carbuncle by making a small incision in the tip. This relieves pain, speeds recovery and helps lessen scarring. Deep infections that can't be completely cleared may be covered with sterile gauze so that pus can continue to drain. Sometimes your doctor may prescribe antibiotics to help heal severe or recurrent infections.
• Eosinophilic folliculitis. A number of therapies are effective against eosinophilic folliculitis, but topical corticosteroids are often the treatment of choice. Your doctor may prescribe a short course of oral corticosteroids if you have a severe infection. All steroids can have serious side effects and should be used for as brief a time as possible. If you're living with HIV/AIDS and have mild eosinophilic folliculitis, your doctor may prescribe topical steroids in conjunction with oral antihistamines. More severe cases may require treatment with isotretinoin (Accutane) for several months.

Although it's not always possible to prevent folliculitis, these measures may help keep you infection-free:

• Avoid constrictive clothing. Tight clothes — especially jeans and athletic wear — may be stylish, but make sure they don't chafe your skin.
• Shave with care. Use an electric razor or a new blade every time you shave. Be especially careful to keep the shaved area clean and to avoid cuts and nicks. If you're a woman who gets frequent infections, you may want to consider depilatories or other methods of hair removal.
• Maintain hot tubs. If you own a hot tub, clean it regularly and add chlorine when recommended. Use commercial tubs only if you're sure they're well maintained.

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:

• Apply a warm, moist washcloth or compress to the affected area several times a day.
• Try an oatmeal lotion or an over-the-counter hydrocortisone cream to help soothe itchy skin.
• Gently wash the infected skin twice a day with antibacterial soap or apply an over-the-counter antibiotic ointment.
• Avoid shaving irritated skin. If you must shave, use an electric razor rather than a blade, and apply a soothing after-shave lotion when you're finished.
• To help a boil or carbuncle burst and drain more quickly, apply a soft cloth soaked in warm salt water to the affected area for about 30 minutes several times a day. Prepare the salt water by adding 1 teaspoon of salt to 1 quart of boiling water. Let cool until comfortably warm.
• Don't share your towels or washcloths, and launder them in plenty of hot, soapy water after every use. Wash clothes that cover the affected areas after each wearing.

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Hot tub folliculitis

Folliculitis 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.

Symptoms    

• history of using hot tub within last three days
• itchy, bumpy, red rash appearing within 2 days of hot tub exposure
• bumps may develop into dark red tender nodules
• may develop small pustules (pus filled blisters)
• multiple members of family or party with same rash and same hot tub exposure

Signs and tests 

Physical 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    

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.

Expectations (prognosis) 

This condition usually clears without scarring. It may recur if the infected hot tub is not cleaned.

Complications    

• abscess formation (rare)
• discomfort

Calling your health care provider    

Call your health care provider if you develop symptoms of hot tub folliculitis.

Prevention    

Careful attention to controlling the pH and chlorine content of the hot tub may help to prevent hot tub folliculitis.

Update Date: 1/11/2003

http://www.nlm.nih.gov/medlineplus/ency/article/001460.htm

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Pityrosporum Folliculitis

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

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:

External

• The yeast tends to overgrow in hot, humid, sweaty environments.
• Occlusive clothing, especially synthetic, encourages sweating.
• Application of cream-based sunscreens and oily emollients such as olive or coconut oil.

Host factors

• An oily-skin tendency - the yeast feeds on skin oil. Skin oil production mainly depends on hormone factors.
• Decreased resistance to microorganisms (immunity).
• Stress or fatigue
• Diabetes
• Oral steroids such as prednisone
• Oral contraceptive pill
• Being overweight, resulting in more sweating and tighter clothing.
• Oral antibiotics such as tetracycline can aggravate pityrosporum folliculitis because skin-inhabitant bacteria and yeasts are normally in competition on the skin surface. When the bacteria are suppressed by antibiotics the pityrosporum yeasts can over grow.

Symptoms

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.

Treatment

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:

Local

• Selenium disulphide shampoo, initially applied for 30 minutes followed by a shower on 3 consecutive days, then once a week.
• 50% propylene glycol in water applied twice daily with a gauze pad for 3 weeks, then twice a week.
• Econazole foaming solution (in sachets), lathered up over the skin surface, left on for 5 minutes before washing off, nightly for 5 days then weekly.
• For just a few spots: apply ketoconazole cream twice a day.

Oral

• Ketoconazole
• Itraconazole In New Zealand, Drug Tariff subsidy on itraconazole requires specialist prescription or recommendation.

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Folliculitis decalvans

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.

• Oral antibiotics such as minocycline, tetracycline, rifampicin, clindamycin, fusidic acid, ciprofloxacin and dicloxacillin have all been tried with varying results from patient to patient.
• In some severe forms, addition of an oral corticosteroid may be necessary.
• Oral isotretinoin has also been tried with some success.

DermNetNZ

 

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Abstracts and Studies

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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. aido1@mac.com

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.

Blackwell Synergy

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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.

Elsevier Masson,fr

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Eosinophilic pustular folliculitis.

Fox GN, Stausmire JM, Mehregan DR. - Department of Pathology, National University Hospital, Singapore 119074, Singapore.

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.

PubMed

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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.

Journal of the American Academy of Dermatology

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Traction folliculitis: an underreported entity.

Cutis. 2007 Jan

Medical University of Ohio, Toledo, USA. foxgary@yahoo.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]

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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.

Blackwell Synergy

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Industrial Pseudomonas folliculitis.

Am J Ind Med. 2006 Nov

Center for Toxicology and Environmental Health (CTEH), Little Rock, Arkansas 72201, USA. dhewitt@cteh.com

INTRODUCTION: Complaints of poor water quality and skin rashes among workers at a US cardboard manufacturing 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

Wiley Interscience

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External Links

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Folliculitis

http://www.merck.com/mrkshared/mmanual/section10/chapter112/112i.jsp

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Folliculitis

http://www.skinsite.com/info_folliculitis.htm

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Folliculitis

http://www.emedicine.com/derm/topic159.htm

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Folliculitis

http://www.nlm.nih.gov/medlineplus/ency/article/000823.htm

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Malassezia folliculitis

http://dermnetnz.org/fungal/pityrosporum-folliculitis.html

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Folliculitis decalvans

http://www.dermnetnz.org/hair-nails-sweat/folliculitis-decalvans.html

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Folliculitis keloidalis

http://www.dermnetnz.org/acne/keloid-acne.html

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Diagnostic Images

Google

http://images.google.com/images?hl=en&q=folliculitis&gbv=2

Yahoo

http://images.search.yahoo.com/search/images?p=folliculitis&fr=yfp-t-501&toggle=1&cop=mss&ei=UTF-8

DermNet NZ Folliculitis

Folliculitis is the name given to a group of skin conditions in which there are inflamed hair follicles.

http://www.dermnetnz.org/acne/folliculitis.html

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Diagnostic Codes and Resources

ICD-10	L73.9 (ILDS L73.91) Follicular disorder, unspecified
ICD-9	704.8 2008 ICD-9-CM Diagnosis 704.8 Other specified diseases of hair and hair follicles 704.8 is a specific code that can be used to specify a diagnosis 704.8 contains 21 index entries View the ICD-9-CM Volume 1 704.* hierarchy 704.8 also known as: Folliculitis: NOS abscedens et suffodiens pustular Perifolliculitis: NOS capitis abscedens et suffodiens scalp Sycosis: NOS barbae [not parasitic] lupoid vulgaris
DiseasesDB	31367
MedlinePlus	000823
eMedicine	derm/159
MeSH	D005499

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Related Lymphedema People Medical Blogs and Pages:

Bacterial Infections

http://bacteriainfections.blogspot.com

Antibiotics

http://antibioticinformation.blogspot.com/

Cellulitis

http://cellulitisinfections.blogspot.com/

MRSA Information

http://mrsainformation.blogspot.com/

Antibiotic Glossary

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=34

Antibiotic Therapy, Types of Antibiotics

http://www.lymphedemapeople.com/thesite/lymphedema_antibiotics.htm

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Join us as we work for lymphedema patients everywehere:

Advocates for Lymphedema

Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.

http://health.groups.yahoo.com/group/AdvocatesforLymphedema/

Subscribe:

AdvocatesforLymphedema-subscribe@yahoogroups.com

Pat O'Connor

Lymphedema People / Advocates for Lymphedema

===========================

For information about Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema\

For Information about Lymphedema Complications

http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema

For Lymphedema Personal Stories

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=3

For information about How to Treat a Lymphedema Wound

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound

For information about Lymphedema Treatment 

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment

For information about Exercises for Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema

For information on Infections Associated with Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema

For information on Lymphedema in Children

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children

Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

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Lymphedema People - Support Groups

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Children with Lymphedema

The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.

http://health.groups.yahoo.com/group/childrenwithlymphedema/

Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com

......................

Lipedema Lipodema Lipoedema

No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.

Come join, be a part of the family!

http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515

Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com

......................

MEN WITH LYMPHEDEMA

If you are a man with lymphedema; a man with a loved one with lymphedema who you are trying to help and understand come join us and discover what it is to be the master instead of the sufferer of lymphedema.

http://health.groups.yahoo.com/group/menwithlymphedema/

Subscribe: menwithlymphedema-subscribe@yahoogroups.com

......................

All About Lymphangiectasia

Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.

http://health.groups.yahoo.com/group/allaboutlymphangiectasia/

Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com

......................

Lymphatic Disorders Support Group @ Yahoo Groups

While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.

DISCRIPTION

Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.

http://health.groups.yahoo.com/group/lymphaticdisorders/

Subscribe: lymphaticdisorders-subscribe@yahoogroups.com

......................

All About Lymphedema

For our Google fans, we have just created this online support group in Google Groups:

Homepage: http://groups-beta.google.com/group/All-About-Lymphedema

Group email: All-About-Lymphedema@googlegroups.com

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Lymphedema Friends

http://groups.aol.com/lymphedemafriend

If you an AOL fan and looking for a support group in AOL Groups, come and join us there.

===========================

Lymphedema People New Wiki Pages

Have you seen our new “Wiki” pages yet?  Listed below are just a sample of the more than 140 pages now listed in our Wiki section. We are also working on hundred more.  Come and take a stroll! 

Lymphedema Glossary 

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing 

Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema 

Arm Lymphedema  

http://www.lymphedemapeople.com/wiki/doku.php?id=arm_lymphedema 

Leg Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=leg_lymphedema 

Acute Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=acute_lymphedema 

The Lymphedema Diet 

http://www.lymphedemapeople.com/wiki/doku.php?id=the_lymphedema_diet 

Exercises for Lymphedema  

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema 

Diuretics are not for Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=diuretics_are_not_for_lymphedema 

Lymphedema People Online Support Groups 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_people_online_support_groups 

Lipedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=lipedema 

Treatment 

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment 

Lymphedema and Pain Management 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pain_management 

Manual Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)

http://www.lymphedemapeople.com/wiki/doku.php?id=manual_lymphatic_drainage_mld_complex_decongestive_therapy_cdt 

Infections Associated with Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema 

How to Treat a Lymphedema Wound 

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound 

Fungal Infections Associated with Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=fungal_infections_associated_with_lymphedema 

Lymphedema in Children 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children 

Lymphoscintigraphy 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphoscintigraphy 

Magnetic Resonance Imaging 

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging 

Extraperitoneal para-aortic lymph node dissection (EPLND) 

http://www.lymphedemapeople.com/wiki/doku.php?id=extraperitoneal_para-aortic_lymph_node_dissection_eplnd 

Axillary node biopsy 

http://www.lymphedemapeople.com/wiki/doku.php?id=axillary_node_biopsy

Sentinel Node Biopsy 

http://www.lymphedemapeople.com/wiki/doku.php?id=sentinel_node_biopsy

 Small Needle Biopsy - Fine Needle Aspiration 

http://www.lymphedemapeople.com/wiki/doku.php?id=small_needle_biopsy 

Magnetic Resonance Imaging 

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging 

Lymphedema Gene FOXC2

 http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_foxc2

 Lymphedema Gene VEGFC

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_vegfc

 Lymphedema Gene SOX18

 http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_sox18

 Lymphedema and Pregnancy

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pregnancy

Home page: Lymphedema People

http://www.lymphedemapeople.com

Page Updated: April 13, 2008