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Folliculitis

Medicine > Infection

Background knowledge 🧠

Definition

  • Inflammation of hair follicles.
  • Can occur anywhere on the body where hair is present.
  • Commonly affects areas like the face, scalp, thighs, and buttocks.

Epidemiology

  • Affects people of all ages.
  • Common in individuals with diabetes or immunocompromised states.
  • Increased prevalence in those who shave or wax regularly.

Aetiology and pathophysiology

  • Typically caused by bacterial infection, commonly Staphylococcus aureus.
  • Can also be due to fungal or viral infections.
  • Non-infectious causes include chemical irritation or mechanical irritation from shaving.
  • Pathophysiology involves inflammation around hair follicle leading to pustule formation.

Clinical Features 🌡️

Symptoms

  • Itching or burning sensation in affected areas.
  • Pain or tenderness around hair follicles.
  • Clusters of small red bumps or white-headed pimples around hair follicles.
  • In severe cases, large swollen bumps or boils can form.

Signs

  • Red, inflamed follicles.
  • Pus-filled blisters that may break and crust over.
  • Formation of crusts or scabs over follicular lesions.
  • In chronic cases, darkened skin (hyperpigmentation) or scarring.

Investigations 🧪

Tests

  • Clinical diagnosis primarily based on history and examination.
  • Swab of pustule for bacterial culture and sensitivity if infection is severe or recurrent.
  • Skin scraping for fungal culture if fungal folliculitis is suspected.
  • Blood tests and imaging rarely required, unless there are signs of systemic infection.

Management 🥼

Management

  • Good hygiene: Regular washing with antibacterial soap.
  • Topical antibiotics: Mupirocin or clindamycin for mild bacterial folliculitis.
  • Oral antibiotics: For more severe infections (e.g., flucloxacillin).
  • Antifungal treatments: Topical or oral antifungals for fungal folliculitis.
  • Avoid shaving the affected area until symptoms resolve.

Complications

  • Recurrent or chronic folliculitis.
  • Furunculosis (boils).
  • Scarring and post-inflammatory hyperpigmentation.
  • Secondary bacterial infections.
  • Cellulitis if infection spreads to surrounding skin.

Prognosis

  • Generally good with appropriate treatment.
  • Most cases resolve without complications.
  • Chronic or recurrent cases may require long-term management.
  • Patient education on prevention can reduce recurrence.

Key points

  • Maintain good hygiene to prevent folliculitis.
  • Topical treatments are effective for mild cases.
  • Oral antibiotics may be needed for severe or recurrent cases.
  • Consider non-infectious causes in differential diagnosis.
  • Educate patients on proper shaving techniques to prevent pseudofolliculitis barbae.

References

  • British Association of Dermatologists (BAD). Folliculitis – Patient Information Leaflet.
  • NHS UK. Folliculitis Overview and Treatment.
  • BMJ Best Practice. Folliculitis – Diagnosis and Management.
  • Clinical Dermatology by Thomas P. Habif.
  • Dermatology: An Illustrated Colour Text by David Gawkrodger.

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Infection