Folliculitis infection wiki
Dr.Kut | Dec 17, 2009 | Comments 1
What is Folliculitis?
Folliculitis is a skin infection characterized by swelling and abscess formation involving the hair follicles. Acne and Folliculitis share common characteristics of inflammation and pus formation, but the fact remain on the clear association of Acne only with sebaceous or oil glands of the skin. This is classified superficial or deep according to the depth of invasion and to the causative bacteria involved. Usually if a superficial folliculitis was left untreated it could extend deeply beyond the dermis thus developing a furuncle.
Folliculitis Pathophysiology:
Normally, our hair harbors a number of bacteria which substantially consists of staphylococcus aureus. Due to this fact, our hair follicle acts as a vessel for many bacteria causing inflammation and infection. Other pathophysiologic causes are follicular obstruction and trauma, as well as autoimmune processes against sebum causing eosinophilic folliculitis.
Folliculitis symptoms:
On visual inspection, folliculitis appears as 2-5 mm elevation on the skin containing purulent material on the involved area of hair follicle. It is red, painful, and itchy in which may crust on top. The commonly involved areas are the scalp, bearded areas on men, neck, axilla, thighs, buttocks, and groin.
How Folliculitis classified: Types of folliculitis
The classifications of folliculitis depend on the depth of invasion and the causative bacteria involved. Superficial folliculitis named “follicular” or “Bockhart impetigo”, are usually small, and usually arises from the upper portion or opening of a hair follicle. This is commonly located on the scalp of children and on the beard area, axilla, buttocks, and extremities of adults. On the other hand, deep folliculitis affects the entire hair follicle. If this type of folliculitis was left untreated, further invasion will occur which may lead to deep and chronic infection. Below is the list of the classifications of folliculitis in accordance to the causative agent involved.
A) Bacterial Folliculitis
a) Staphylococcal folliculitis – Periporitis staphylogenes (secondary infection of miliaria among neonates), Superficial (follicular or Brockhart impetigo), Deep folliculitis.
b) Pseudomonas aeruginosa folliculitis – “hot tub” folliculitis
c) Gram-negative folliculitis – acne vulgaris common on the face
d) Syphilitic folliculitis
B) Fungal Folliculitis
a) Dermatophytic folliculitis – Tinea capitis, Tinea barbae, Majocchi granuloma
b) Candida folliculitis
C) Viral Folliculitis
a) Herpes simplex virus folliculitis
b) Follicular molluscum contangiosum
Folliculitis risk factors:
Risk factors may include prolonged exposure to bacteria containing dust, mineral oil, tar products, and other irritant chemicals. Commonly affected are bearded men who develop infected hair follicles occurring on the face, upper lip, and chin. Children may also acquire follicular inflammation on the scalp. For the adults, buttocks, axilla, and extremities are commonly affected.
What is the prognosis and common complication of folliculitis?
In most cases, folliculitis has a good prognosis because it’s easy to diagnose and is very curable. Ways of preventing such skin condition is quite attainable and altogether manageable. This disease is noncommunicable and predominantly heals without intervention especially when complication is not evident. Common complications of folliculitis include cellulitis, furunculosis, scarring, and hair follicle destruction or hair loss. Although in most cases this skin disease is treatable, systemic infection may still occur if secondary infection develops or when infected individuals are non-compliant to treatments.
folliculitis Diagnosis
Physicians usually diagnose folliculitis by visual inspection alone. Normally, a positive diagnosis can be made by the presence of the characteristic pustule common among the infected. However, if the symptoms remain persistent despite of treatments provided, Gram stain and wound culture is performed in order to determine the type of bacterial pathogen involved. If a probable fungal infection is evident, potassium chloride (KOH) preparation is done. For any suspected eosinophilic folliculitis, skin biopsy is usually utilized.
Gram stain and wound culture is done by slicing the upper portion of the pustular lesion then placed on a sterile glass slide where it can be sent to the laboratory for culture. The extracted specimen is usually placed on a culture media and after 48-72 hours, this specimen is studied for any bacterial or fungal growth.
Fungal infections are commonly diagnosed using the potassium chloride (KOH) preparation and is performed by scraping the scaly, outer portion of the infected area. The collected specimen is placed on a glass slide where it is mixed with 10% KOH solution. Later it is visualized under a microscope for presence of any fungal elements.
Skin biopsy procedure for cases of probable eosinophilic type of follicular infection is commonly done under anesthesia since the whole skin lesion is removed. Afterwards, the specimen is reviewed by a pathologist for any evidence of histological pathology to determine further cause of symptoms.
Folliculitis treatment:
Initial local application of moist heat over the infected area mostly provides relief of discomfort and promotes drainage. Topical and oral antibiotics are used and should cover the gram positive bacterial organisms. Topical antibiotics utilized are erythromycin, clindamycin, and mupirocin. When systemic infection is suspected, oral antibiotics with wide-coverage is used which include cephalosphorins and dicloxacillin. In cases of chronic infections which may cause systemic illness, maximum dosage of antibiotic is given usually by parenteral route. For Methyllin-resistant organisms, drug of choice used are clindamycin, trimethoprin-sulfamethoxazole, linezolid, and vancomycin. Antibiotic treatments are usually given for at least one week.
As with fungal and viral related folliculitis, intervention used are Ketoconazole and Famcyclovir. In worst cases of large, localized and tender lesions, drainage is facilitated. This procedure helps reduce swelling, promote comfort, and prevent further penetration of the infection over the underlying tissues of the skin. Mupirocin ointment is effective for such cases and sterile moist dressings should be applied to further prevent spread of infection.
Folliculitis Methods of Prevention:
Good sanitation is a rule in order to prevent folliculitis. Proper hand washing and using of anti-bacterial soap is the pioneer of prevention. Exposure to chemicals such as mineral oils and tar products should not be advocated so as not to cause irritant folliculitis. For deep folliculitis, local treatment with warm saline compress prevents the possible spread of infection deep into the dermal part of skin.
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Filed Under: Infection • Skin, Hair and Nails • Staphylococcal Infections
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