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Folliculitis

Posted on: November 1, 2015


SUMMARY

Folliculitis (also known as hot tub rash) is the infection and inflammation of one or more hair follicles. The condition may occur anywhere on the skin with the exception of the palms of the hands and soles of the feet. They may appear as red dots that come to white tips on the chest, back, arms, legs, and head.
CAUSES
Most carbuncles, furuncles, and other cases of folliculitis develop from Staphylococcus aureus and Pseudomonas aeruginosa.
Folliculitis starts when hair follicles are damaged by friction from clothing, an insect bite, blockage of the follicle, shaving, or braids too tight and too close to the scalp. In most cases of folliculitis, the damaged follicles are then infected with the bacterium Staphylococcus. Folliculitis usually affects those in their early adult life, and may persist till their early 30s. Warmer weather may worsen the condition.
Iron deficiency anemia is sometimes associated with chronic cases.
Fungal
Tinea barbae is similar to barber’s itch, but the infection is caused by the fungus T. rubrum.

Malassezia folliculitis, formerly known as Pityrosporum folliculitis, is caused by yeasts (fungi) of the genus Malassezia.

Bacterial
Hot-tub folliculitis is caused by the bacterium Pseudomonas aeruginosa. The folliculitis usually occurs after sitting in a hot tub that was not properly cleaned before use. Symptoms are found around the body parts that sit in the hot tub-typically the legs, hips, buttocks, and surrounding areas. Symptoms are typically amplified around regions that were covered by wet clothing, such as bathing suits.

Sycosis vulgaris, Sycosis barbae or Barber’s itch is a staphylococcus infection of the hair follicles in the bearded area of the face, usually the upper lip. Shaving aggravates the condition.

Gram-negative folliculitis may appear after prolonged acne treatment with antibiotics.

Viral
Herpetic folliculitis may occur when Herpes Simplex Virus infection spreads to nearby hair follicles – mostly around the mouth.

Non-infectious
Pseudofolliculitis barbae is a disorder occurring when hair curves back into the skin and causes inflammation.

Eosinophilic folliculitis may appear in persons with impaired immune systems.

Folliculitis decalvans or tufted folliculitis usually affects scalp. Several hairs arise from the same hair follicle. Scarring and permanent hair loss may follow. The cause is unknown.

Folliculitis keloidalis scarring on the nape of the neck, most common among males of curly hair.

Oil folliculitis is inflammation of hair follicles due to exposure to various oils and typically occurs on forearms or thighs. It is common in refinery workers, road workers, mechanics, and sheep shearers. Even makeup may cause it.

Malignancy may also be represented by recalcitrant cases.

TREATMENT
Topical antiseptic treatment is adequate for most cases

Topical antibiotics such as mupirocin or neomycin containing ointment

Some patients may benefit from systemic narrow-spectrum penicillinase-resistant penicillins (such as dicloxacillin in US, or flucloxacillin in UK)

Fungal folliculitis can worsen with antibiotics and may require an oral antifungal such as Fluconazole. Topical antifungals such as Econazole Nitrate may also be effective.

Folliculitis may reoccur even after symptoms have gone away.
SYMPTOMS
rash (reddened skin area)

itching skin

pimples or pustules located around a hair follicle

may crust over

typically occur on neck, armpit, or groin area

may present as genital lesions

spreading from leg to arm to body through improper treatment of antibiotics.

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