Folliculitis is clinically defined as an active inflammation of one or more hair follicles found anywhere in the skin. The inflammation in folliculitis is often caused by Staphylococcus aureus and less commonly by Pseudomonas aeroginosa.
In general, folliculitis presents with the following common cutaneous symptomatology among patients:
- Clustering of red bumps in a skin region
- Pustule formation or development of a white headed pimple at the base of the hair follicle
- Pus formation with blisters or vesicles 
- Crusting lesions with suppuration
- Pain and tenderness felt on the lesion
- Formation of a large swollen bump or mass
- Erythema formation with inflammation
- Pain and pruritus at the lesion
- Circinate plaque formation with central pustules
- Hypertrophic scarring
Entire Body System
- Exposure to Contaminated Water
Abstract Pseudomonas folliculitis (PF) is a community-acquired skin infection, which develops after exposure to contaminated water such as whirlpools, swimming pools, water slides and hot tubs. [ncbi.nlm.nih.gov]
These small bumps are often itchy and appear 8 to 48 hours after exposure to contaminated water with Pseudomonas aeruginosa. [therapeutique-dermatologique.org]
Oral ivermectin, 12 mg, was given, and the eruption cleared within 24 hours. [ncbi.nlm.nih.gov]
Although the pathophysiology of the acneiform eruption secondary to epidermal growth factor receptor inhibitors is poorly understood, it is hypothesized that the papulopustular eruption occurs secondary to inhibition of follicular epidermal differentiation [emedicine.com]
- Acne Vulgaris
The history and pathophysiology of gram-negative folliculitis in the setting of acne vulgaris is reviewed. [ncbi.nlm.nih.gov]
Clinical Characteristics and Treatment of 6 Patients With Concurrent Pityrosporum Folliculitis and Acne Vulgaris Pityrosporum folliculitis may be underdiagnosed because it can mimic acne vulgaris. [jamanetwork.com]
Deep- (usually granulomatous)- Fungi or bacteria II Non infectious- Superficial- (usually suppurative)- Acne vulgaris, rosacea, follicular mucinosis, steroid induced. [histopathology-india.net]
Therefore, the possibilities of follicular eczema and follicular contact dermatitis were also considered as possible diagnoses for his condition. [cureus.com]
scabies, eczema) Exposure to poorly chlorinated swimming pools/hot tubs or water contaminated with P. aeruginosa, A. hydrophila, or schistosomes Occlusive corticosteroid use (for multiple hours) Bacteria Most frequently due to S. aureus (increasing [unboundmedicine.com]
The same yeast can cause pityriasis versicolor and seborrhoeic eczema Malassezia can be found on the skin of most adults, it only causes folliculitis when conditions are right. [pcds.org.uk]
Types & treatments Childhood eczema Adult eczema Insider secrets Types of hair loss Treatment for hair loss Causes of hair loss Hair care matters Insider secrets What is psoriasis Diagnosis & treatment Skin, hair & nail care Triggers Insider secrets What [aad.org]
Eczema Resource Center - Caring for a child with eczema Atopic dermatitis Contact dermatitis Dry, scaly, and painful hands could be hand eczema Dyshidrotic eczema Neurodermatitis Nummular dermatitis Stasis dermatitis Hair and scalp problems Many people [skincarephysicians.com]
This case is presented to emphasize that scabies should be considered in the differential diagnosis in cases of chronic pruritus. [go.gale.com]
RESULTS: Of 110 qualifying patients, more than 75% had acne that had recently been treated with antibiotics, and when recorded, 65% reported pruritus. [ncbi.nlm.nih.gov]
Causes intense pruritus, particularly in areas under a bathing suit [ 2, 3 ]. [patient.info]
- Skin Rash
Here, we report an unusual case of NICF presented as an uncommon generalized skin rash in an adolescent. In addition, we present analysis using infrared microscopy for improved characterization of this crystalline material. [ncbi.nlm.nih.gov]
Whether or not you're a celebrity, chances are you or someone you've know has at one time suffered from folliculitis, a common, irritating skin rash that can turn into fluid-filled bumps. [health.howstuffworks.com]
— Korin Miller, SELF, "9 Questions That Will Help You Decode That Skin Rash," 22 Mar. 2019 Vulvar acne shows up in red bumps, and is a form of folliculitis, which is an inflammation around the hair follicles. — Yerin Kim, Seventeen, "What Is Vaginal [merriam-webster.com]
Rash improves, but then comes back 2000-2019 The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. [fairview.org]
Snapshot A 25-year-old woman presents to her dermatologist reporting a new itchy skin rash. She reports going to a pool party recently, where she shared a hot tub with 10 other people. [medbullets.com]
- Genital Lesions
Signs and symptoms rash (reddened skin area) itching skin pimples or pustules located around a hair or follicle; may be confused with chicken pox may crust over typically occur on neck, armpit, or groin may present as genital lesions spreading from [en.wikipedia.org]
These lesions may also present as genital lesions. It is a characteristic feature of these lesions to spread from leg to arm to body through improper treatment with antibiotics. [xpertdox.com]
A complete and detailed clinical history of the lesion will give away the diagnosis of folliculitis to the primary physician. Laboratory tests are not the primary workup procedure, and are ordered only when the history and physical examination doesn't lead easily to diagnosis. When the empiric treatment appears to be unresponsive, swabs of the secretions may be taken for culture and sensitivity to determine the causative agent and its respective sensitivity to antibiotics . Skin biopsy may sometimes be done to rule out other cutaneous disease conditions .
- Citrobacter Koseri
We report a case of severe Citrobacter koseri folliculitis of the face in a boy with acne. A 15-year-old boy affected by acne was admitted because of a rash located on the face. [ncbi.nlm.nih.gov]
Citrobacter koseri in scalp folliculitis. Cutis 2002;69:393-4. 4. Laymon CW. The cicatricial alopecias; an historical and clinical review and an histologic investigation. J Invest Dermatol 1947;8:99-122. 5. Smith NP, Sanderson KV. [ijtrichology.com]
- Trichophyton Rubrum
Four patients were diagnosed with dermatophytic folliculitis (Trichophyton rubrum in three patients and Arthroderma vanbreuseghemii in one patient), and two patients were diagnosed with Candida albicans folliculitis. [ncbi.nlm.nih.gov]
In general, the treatment of choice for folliculitis is greatly dependent on the severity of the disease. For mild folliculitis, antibiotic creams (mupirocin) may be used while oral antibiotics (cephalexin) for 7 to 10 days may be given for recurrent cases. For fungal folliculitis, topical antifungals may be used for folliculitis caused by yeasts and fungus like those seen in Pityrosporum folliculitis. For autoimmune or eosinophilic folliculitis, patients may be given steroid creams (betamethasone) and oral corticosteroids for severe inflammation.
Patients presenting with large boils and carbuncles may be surgically incised and drained to reduce the scarring of the skin and other complications. Light and laser therapy are reserved for refractory cases of folliculitis which are not responsive to common treatment modalities .
Superficial folliculitis almost always resolves without any intervention or treatment. Severe forms of folliculitis may respond well with treatment but there is a very high recurrence rate. Mortality from primary folliculitis is rare. There is increasing morbidity coupled to severe complications like cellulitis, chronic scarring, furunculosis, abscess formation, carbuncle formation, and permanent hair loss.
Folliculitis is most often caused by the bacterium Staphylococcus aureus. This cutaneous infection could further be classified as either superficial or deep depending on how much hair follicle is involved. The deeper the folliculitis the more severe the disease conditions and the more complicated is its clinical course and treatment. Any break in the integrity of the follicles can predispose it to bacterial, viral or fungal infections. The following everyday conditions are associated with follicular damage:
The occurrence of superficial folliculitis is very common all over world. Because most cases resolve spontaneously, only a few cases are brought to the physician for medical care and recording. Patients are found to be more susceptible to folliculitis if they are diabetics, on immunosuppressive drugs, having preexisting dermatoses, on long term antibiotics use, on chronic anti-retroviral therapy , and on chronic occlusive dressings. Folliculitis has been frequently observed among military personnel on the site of their anthrax and small pox immunizations .
There is no sexual or racial predilection for the common folliculitis. Although, the incidence of pseudofolliculitis or traction folliculitis are more common among Afro-Americans , while the Japanese are more prone to the eosinophilic type of folliculitis . Folliculitis may also occur in all age groups.
Superficial folliculitis may occur due to hair follicle occlusion or direct trauma to the follicles. In can also occur as a secondary infection after a primary cutaneous infection spreads contiguously towards the hair follicle. Autoimmune forms of folliculitis or eosinophilic folliculitis are postulated to occur due to the antibodies that attack the sebum and the sebocytes (fat cells) of the body. Theories have been brought to light that the papulopustular eruptions that occur in superficial folliculitis are due to the abnormal epidermal differentiation that leads to follicular obstructions and inflammations .
Folliculitis may easily prevented from recurring if the underlying disease is treated and controlled like those with diabetes mellitus and tuberculosis. Patients with recurrent barber’s itch on the mustache area may opt not to shave them and grow beards instead. The use of shaving creams may brace the skin and prevent follicular damage in the process.
Folliculitis occurring in areas of high friction may be avoided by loosening the garment or fabric that causes the perennial friction. Rubber gloves must be thoroughly cleaned and dried in between uses to prevent skin infections. Cleaning of hot tubs with chlorine can help prevent the propagation of the bacteria Pseudomonas aeroginosa that can infect the skin .
Folliculitis is a very common skin infection that starts at the hair follicles of the skin. Folliculitis is sometimes referred to as hot tub rash, razor bumps, and barber’s itch. It is caused by various microorganisms. It is usually brought about by bacterial, viral (herpes), or fungal (yeast) infections. The infection may start as a reddish macule or a white headed pustule but can later complicate into a non-healing and crusting lesion. Milder forms of folliculitis will present with a sore and itchiness while severe forms of folliculitis may cause scarring and permanent hair loss in the affected area.
Folliculitis is clinically defined as an active inflammation of one or more hair follicles found anywhere in the skin.
A complete clinical history and direct physical examination of the skin, skin swab for culture and sensitivity testing  may be used to diagnose the condition.
Treatment and follow-up
Patients are given topical and oral antibiotics and anti-fungal agents. Phototherapy and laser therapy.
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- Yu Y, Cheng AS, Wang L, Dunne WM, Bayliss SJ. Hot tub folliculitis or hot hand-foot syndrome caused by Pseudomonas aeruginosa. J Am Acad Dermatol. Oct 2007; 57(4):596-
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