Folliculitis

Folliculitis is the name given to a specific group of skin conditions characterized by the inflamed hair follicles. The result is a tender red spot, often with a surface pustule. There are several possible causes of folliculitis - the condition can be caused by an infection, occlusion, irritation and specific skin diseases. This condition can affect both women and men at any age and it can develop on any part of the body, but is most likely to occur on the scalp, face, or parts of the arms, armpits, or legs if they’re not usually covered by clothing.

 

Possible causes of folliculitis

It is proven that this condition develops when bacteria such as Staphylococcus, or a fungus enters the body through a cut, scrape, surgical incision, or other break in the skin near a hair follicle. Scratching the affected area can trap fungus or bacteria under the fingernails and spread the infection to hair follicles on other parts of the body. The bacteria that cause folliculitis are contagious which means that a person who has folliculitis can infect others who live in the same household.
 

Signs, symptoms and treatment of folliculitis

The symptoms may vary, depending on the type of infection. There are two types of folliculitis, the superficial form and the deep form. In superficial forms of the disorder, small pimples develop around one or more hair follicles.  Deep folliculitis, which affects the entire hair follicle, can cause more severe signs and symptoms.

The types of superficial folliculitis:

•    Pseudomonas folliculitis
The bacterium that causes this type of folliculitis can be found in a wide range of environments, including wooden hot tubs. The symptoms are characteristic and they appear about 12 to 48 hours after being exposed to the bacteria. Patients are complaining of numerous red, round, itchy bumps that later may develop into small pus-filled blisters.

Treatment: This type of folliculitis rarely requires treatment, although sometimes the doctor may prescribe an oral or topical medication to help relieve itching.

•    Barber's itch
This type of folliculitis is characterized by itchy, white, pus-filled lumps in the beard area in men. It usually occurs when hair follicles that have been irritated by shaving become infected with Staphylococcus aureus bacteria. Although this bacterium live on your skin all the time, they cause problems when they enter the body through a cut.

Treatment: In most cases the doctor will advise you not to shave the affected area until the infection heals. This should probably be enough but, if the problem persists, you may need topical or oral antibiotics.

•    Tinea barbae
Unlike the previous types, tinea barbae is caused by a fungus. It also develops in the beard area in men. It is characterized by itchy, white bumps. The surrounding skin also may become reddened. 

Treatment: This infection it is usually being effectively treated with oral antifungal medications.

•    Pseudofolliculitis barbae
This is also an inflammation of the hair follicles in the beard area. It is called pseudofolliculitis because it develops when shaved hairs curve back into the skin, leading to inflammation and dark raised scars.

Treatment: Experts are saying that the best treatment for this condition is preventive which include simple shaving with an electric razor. When using the razor it is best to use also a shaving gel instead of cream, and shave in the direction of the hair growth.

•    Pityrosporum folliculitis
This condition is very common, especially in young and middle-aged adults. This type of 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 a fungus infection called Malassezia furfur.

Treatment: Topical or oral antifungal medications are the most effective treatments for this type of folliculitis. It is proven that antibiotics aren't helpful in treating pityrosporum folliculitis and may even make the infection worse.

•    Herpetic folliculitis
Sometimes the virus called Herpes Simplex can enter the skin through the small lesions made by shaving. From there it can spread to surrounding follicles.

Treatment: The doctor may prescribe an oral antiviral medication such as acyclovir, famciclovir or valacyclovir. These drugs can clear the infection, but they also may cause side effects such as headache, diarrhea, nausea and abdominal pain.
 
The types of deep folliculitis include:

•    Gram-negative folliculitis
This type of folliculitis occurs most commonly in people who have been using antibiotics to treat acne for a long time. It is proven that antibiotics alter the normal balance of bacteria in the nose, leading to an overgrowth of harmful organisms - gram-negative bacteria.

Treatment: This type of folliculitis is usually treated with certain antibiotics or with Isotretinoin (Accutane®).

•    Boils and carbuncles
Boils occur when hair follicles become deeply infected with staphylococcus bacteria and they look like a painful pink or red bump about a centimeter in diameter. The surrounding skin may also be red and swollen. A carbuncle is actually a cluster of boils that often occurs on the back of the neck, shoulders or thighs, especially in older men and represent a deeper and more severe infection than a single boil. 

Treatment: A doctor should drain every large boil or carbuncle by making a small incision in the tip. This usually relieves pain, speeds recovery and helps lessen the scarring.  The antibiotics are recommended sometimes to help heal severe or recurrent infections.

•    Eosinophilic folliculitis
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 exact cause of eosinophilic folliculitis isn't known, but it is most commonly seen in HIV positive people.

Treatment: Topical corticosteroids are often the treatment of choice. Patients should know that steroids may have serious side effects and should be used for as brief a time as possible

Risk factors for developing folliculitis

There are some conditions which can make a person more prone to developing folliculitis. They include:

•    Acne or dermatitis
•    Trauma to your skin from surgery
•    Long-term antibiotic therapy for acne
•    Topical corticosteroid therapy
•    Diabetes, chronic leukemia, organ transplantation and HIV/AIDS
•    Obesity — folliculitis is more common in people who are overweight
•    Living in a warm, humid climate
•    Using a hot tub, whirlpool, or swimming pool that is not properly treated with chlorine.
•    Wearing tight clothes.
•    Use or work around substances that can irritate or block the follicles
•    Have an infected cut, scrape, or surgical incision.

 

Diagnosis of folliculitis

•    Detailed patients history and examination
To diagnose folliculitis, the doctor will examine the patient’s skin and ask questions about his health and activities.

•    Culture of the fluid in pimples
The doctor may perform a tests to find out what is causing folliculitis and to make sure that the patient isn’t suffering from some other condiditon such as impetigo or heat rash. Examining a sample of the fluid in the pimples can help determine whether bacteria are causing the infection.

•    Skin biopsy
If a fungus is suspected, the doctor will take a tissue sample, or biopsy, of the infected area.

 

Possible complications if left untreated

Mild cases of folliculitis usually do not cause any complications, although the infection may recur or spread, leading to large, itchy patches.

Complications of the more serious infections may include:

•    Cellulitis
This is a very serious bacterial infection. It is characterized by swollen, red area of skin that feels hot and tender. It may spread rapidly on legs, arms or face.  
•    Furunculous
This is also a serious condition which occurs when a number of very painful boils develop under skin.!
•    Scarring
The serious types of folliculitis may leave thick, raised scars or patches of skin that are darker than normal. Destruction of the hair follicle can also lead to permanent hair loss.

 

Alternative treatment

Eating a balanced diet, including protein, complex carbohydrates, healthy fats, fresh fruits and vegetables, and drinking eight to 10 glasses of water a day may stimulate the body's immune system and shorten the course of the infection.

Garlic (Allium sativum) and goldenseal (Hydrastis canadensis), both antiseptic agents against staphylococcal infections, should be taken. Echinacea (Echinacea spp.) is a;so helpful in modulating immune function. Warm compresses made with white vinegar or Burow’s solution may help relieve itching and aid the healing process.

Daily doses of zinc, vitamin C and bioflavinoids can also strengthen the body's infection-fighting ability. In some cases, a laser hair removal may be the only option. Laser treatment destroys the hair follicles so they can't become infected.