Folliculitis – Causes, Symptoms and Treatment

Folliculitis is the name given to a group of skin conditions. Folliculitis is defined histologically as the presence of inflammatory cells. Folliculitis is the infection of hair follicles. This can occur anywhere on the skin or scalp. It may be superficial or deep, and it causes the formation of a pustule or inflammatory nodule surrounding the hair. The inflammation can be either limited to the superficial aspect of the follicle with primary involvement of the infundibulum or the inflammation can affect both the superficial and deep aspects. Severe cases may cause permanent hair loss and scarring, and even mild folliculitis can be uncomfortable and embarrassing. Folliculitis may arise as hairs regrow after shaving, waxing, electrolysis or plucking. Swabs taken from the pustules are sterile i.e. there is no growth of bacteria or other organisms.

It is usually caused by bacteria. Common superficial form of infectious folliculitis is known as impetigo of Bockhart or barbers itch and is caused by Staphylococcus aureus. It can also be caused by yeast and another type of fungus. Folliculitis caused by a fungus is most often seen in people who have trouble fighting infections because they have an impaired immune system. There are also forms of folliculitis which are non-infectious such as those caused by tars, oils and greases that come into contact with the skin. The lesions are seen in the bearded area, often on the upper lip near the nose, as erythematous follicular-based papules or pustules that may rupture and leave a yellow crust. The pustule is often pierced by a hair that is easily extracted from the follicle. This form of folliculitis may occur more commonly in staphylococcal nasal carriers.

Causes of Folliculitis

1. Friction from shaving.

2. Follicular trauma.

3. Excessive perspiration.

4. Occlusion.

5. Inflammatory skin conditions.

Symptoms of Folliculitis

1. Pain.

2. Erythema (inflammation and redness of the skin).

3. Edema.

4. Yellow pus-filled lesions.

5. Small pimples.

Treatment of Folliculitis

Hot tub folliculitis rarely requires treatment, although your doctor may prescribe an oral or topical medication to help relieve itching (anti-pruritic). If the patient is immunocompromised or the lesions are persistent oral ciprofloxacin may be given. Topical antibiotics, such as bacitracin with polymyxin B, may be administered. Fusidic acid is available both as a cream and as an ointment. You should apply it thinly on to the infected area 3-4 times daily. Mupirocin is available both as a cream and an ointment. You should apply it thinly on the affected area 3 times a day for up to 10 days. It may be used on all ages except for in the USA where the Bactroban nasal ointment is not recommended for children under the age of 12. Eosinophilic folliculitis therapies are effective against eosinophilic folliculitis, but topical corticosteroids are often the treatment of choice. Applying moist heat compresses to the local area helps promote vasodilation (dilation of the blood vessels) and drainage from the lesions. Keeping skin clean, dry, and free from abrasions or irritation can help prevent folliculitis. More severe cases may require treatment with isotretinoin (Accutane) for several months.