FOLLICULITIS
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FolliculitisFolliculitis is the infection and inflammation of one or more hair follicles. The condition may occur anywhere on hair-covered skin. The rash may appear as pimples that come to white tips on the face, chest, back, arms, legs, buttocks, or head. Although acne can often involve superficial infection and inflammation of some hair follicles, the condition of those follicles is usually not called folliculitis, as that term is usually reserved for the separate set of disease entities comprising infected and inflamed hair follicles with causes other than acne.
Pseudofolliculitis barbaePseudofolliculitis barbae (PFB) is a type of irritant folliculitis that commonly affects people who have curly or thick facial hair. It occurs when hair curls back into the skin after shaving, causing inflammation, redness, and bumps. This can lead to ingrown hairs, scarring, and skin discoloration. PFB can be treated with various methods, including changing shaving habits, using topical creams or ointments, and undergoing laser hair removal. Prevention measures include proper shaving techniques, using sharp razors, and avoiding too close a shave. It was first described in 1956.
Acne keloidalis nuchaeAcne keloidalis nuchae (AKN), also known as "acne keloidalis", "dermatitis papillaris capillitii", "folliculitis keloidalis", "folliculitis keloidis nuchae", and "nuchal keloid acne",: 526 is a destructive scarring folliculitis that occurs almost exclusively on the occipital scalp of people of African descent, primarily men. AKN is characterized by firm pink, flesh-colored or hyperpigmented bumps in the skin, which are usually located on the back of the head or neck. This is mainly because men often cut their hair very low as opposed to women, allowing the hair to prick the occipital scalp thereby causing irritation. Acne keloidalis nuchae most commonly presents itself in individuals aged 13 to 25. The disease is closely related to pseudofolliculitis barbae and both occur frequently in black men in the military, where it is so common that the US Army has developed official protocols for management. Prolonged cases of AKN can cause keloid formation due to chronic irritation from folliculitis. Bacterial folliculitis and acne can mimic the appearance of AKN; however, unlike acne, comedones are not seen with AKN. Treatments for AKN aim to reduce inflammation and prevent infections and scarring. Therapies for AKN may include topical antibiotics, topical or intralesional corticosteroids, and laser hair removal. Recommended modifications to shaving habits include liberal use of shaving cream, avoidance of stretching the skin while shaving, and use of a single-blade razor rather than a razor with multiple blades.
Hot tub folliculitisHot tub folliculitis, also called Pseudomonal folliculitis or Pseudomonas aeruginosa folliculitis, is a common type of folliculitis featuring inflammation of hair follicles and surrounding skin.: 272 This condition is caused by an infection of the skin and hair follicles by the bacterium Pseudomonas aeruginosa. The bacterium is commonly found in poorly-maintained recreational water sources such as hot tubs, water slides, and swimming pools. Hot tub folliculitis appears on the skin in the form of a rash, roughly resembling chicken pox and then develops further to appear as a pimple. Children are the most likely to be affected. Hot tub folliculitis can be, but is not always, painful and/or itchy. In most cases, the rashes resolve after about 7 to 10 days, only leaving a hyperpigmented lesion that goes away after a few months. Oral antibiotics such as ciprofloxacin may be used to shorten the duration of symptoms.
Pruritic folliculitis of pregnancyPruritic folliculitis of pregnancy is a skin condition that occurs in one in 3000 people, about 0.2% of cases, who are in their second to third trimester of pregnancy where the hair follicle becomes inflamed or infected, resulting in a pus filled bump. Some dermatologic conditions aside from pruritic folliculitis during pregnancy include "pruritic urticarial papules and plaques of pregnancy, atopic eruption of pregnancy, pemphigoid gestationis, intrahepatic cholestasis of pregnancy, and pustular psoriasis of pregnancy". This pruritic folliculitis of pregnancy differs from typical pruritic folliculitis; in pregnancy, it is characterized by sterile hair follicles becoming inflamed mainly involving the trunk, contrasting how typical pruritic folliculitis is mainly localized on "the upper back, shoulders, and chest." This condition was first observed after some pregnant individuals showed signs of folliculitis that were different than seen before. The inflammation was thought to be caused by hormonal imbalance, infection from bacteria, fungi, viruses or even an ingrown hair. However, there is no known definitive cause as of yet. These bumps usually begin on the belly and then spread to upper regions of the body as well as the thighs. This condition does not harm the fetus or the mother and usually resolves after delivery of the baby. The rate of incidence could possibly be higher but due to the unknown etiology of the condition, misdiagnosis, and varying levels of severity, it is difficult to differentiate. Pruritic folliculitis of pregnancy is currently classified as atopic eruption of pregnancy (AEP) in a retrospective study done in 2006 that compared this condition to eczema and prurigo of pregnancy, which occurred in 49.7% and 0.8% of cases respectively, with eczema clearly being more frequent. Unlike typical pruritic folliculitis which does not resolve on its own, pruritic folliculitis of pregnancy clears spontaneously on delivery or in postpartum period. Pruritic folliculitis of pregnancy has no mortality effects or significant adverse effects on the mother or on the fetus. Currently, there are no treatment guidelines for this condition due to the nature of its unknown etiology but symptom relief is strongly emphasized using non-pharmacological interventions such as warm baths or wearing loose clothing. If itchiness and discomfort persists, benzoyl peroxide, low to mid potency topical steroids, or antihistamines can be tried. Novel treatments have also shown potential in treating case studies of pruritic folliculitis of pregnancy, such as using ultraviolet phototherapy. However, further investigation is still required to study its efficacy and safety in second to third trimester pregnant patients.
Malassezia folliculitisMalassezia folliculitis or pityrosporum folliculitis, is a skin condition caused by infection by Malassezia (formerly Pityrosporum) yeast.: 314 The skin of the upper trunk area including the back, chest, arms and sometimes the neck is often affected and this condition is often seen in young to middle aged adults, although it has been known to occur in adults well into their sixties, and can also be found on the lower extremities as well. Its diagnosis is based on the pruritic (itchy) papulopustules found in a follicular pattern in these regions. Pustules are caused by an overgrowth of the yeast Malassezia furfur (formerly Pityrosporum ovale), which plugs the follicles. This yeast is lipophilic, requiring fatty acids that are present in oily skin to proliferate. It has been shown that Malassezia yeast grows by consuming fatty acids with carbon chain lengths C11 to C24. Malassezia is part of the normal skin flora, but overgrows in certain conditions. Overgrowth is associated with oily skin, humidity or other pre-existing dermatologic conditions such as seborrheic dermatitis and severe dandruff.
Irritant folliculitisIrritant folliculitis is an inflammation of the hair follicle. It characteristically presents with small red bumps in the skin at sites of occlusion, pressure, friction, or hair removal; typically around the beard area in males, pubic area and lower legs of females, or generally the inner thighs and bottom. An associated itch may or may not be present. Pseudofolliculitis barbae is a type of irritant folliculitis in the beard area. Mechanical factors that typically trigger irritant folliculitis include hair removal by razor, waxing, electrolysis, and by plucking. Repeated rubbing of skin such as friction on the inner thighs, may result in the irritation. Sunlight, and prolonged pressure such as sitting on one's bottom for long periods of time, may also trigger irritant folliculitis. Irritant folliculitis may occur following the use of some medications or contact with irritant chemicals such as cutting fluids and coal tar. Tight hair styles may cause irritant folliculitis on the scalp. Other factors that increase chances of skin friction and moisture include obesity. Diagnosis is generally by history and visualisation of the rash. The condition is not due to infection and swabs of the spots are typically negative. It may appear similar to acne and other types of infectious folliculitis. Treatment considers removing the triggering factor, particularly to stop shaving. Prolonged use of the antibiotic doxycycline may be an option. If shaving is necessary, the condition may be prevented by avoiding soap and applying a generous amount of shaving gel. Rubbing may be reduced by using powders. Any age may be affected. It is common on the lower legs of women who shave there.
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