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 [6]
• 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 

• Anemia

  Iron deficiency anemia is sometimes present with chronic cases of folliculitis. Bacterial causes of folliculitis include Staphylococcus aureus. Hot-tub folliculitis is caused by the Pseudomonas aeruginosa. [xpertdox.com]

  Iron deficiency anemia is sometimes associated with chronic cases. Bacterial[edit] Staphylococcus aureus folliculitis. [en.wikipedia.org]

• Malaise

  In severe cases, it may progress to a systemic infection where there would be fever and malaise. Diagnosis In folliculitis, inspection usually reveals pustules on the scalp, arms and/or legs; on the face of bearded men; and possibly on the eyelids. [healthcentral.com]

  These include a sudden increase in redness or pain, fever, chills, and a feeling of being unwell (malaise). Types of folliculitis The two main types of folliculitis are superficial and deep. [mayoclinic.org]

  Constitutional symptoms, including fever and malaise, are commonly associated with these lesions but are rarely found with furuncles. [aafp.org]

  If the nodules enlarge and rupture, there may be pus on the skin surface.In severe cases, it may progress to a systemic infection where there would be fever and malaise Causes and Risk factors: Every hair on your body grows from a follicle, a small pocket [medigoo.com]

• Constitutional Symptom

  Some subtypes are aggressive or severe and are associated with constitutional symptoms and systemic involvement. [bioline.org.br]

  Some subtypesAtrophic scars Ice-pick scars are aggressive or severe and are associated with Boxcar scars constitutional symptoms and systemic involvement.Hypertrophic scars Rolling scars This group includes acne conglobata [Figure 44],Mixed scars Perifollicular [fliphtml5.com]

  Constitutional symptoms, including fever and malaise, are commonly associated with these lesions but are rarely found with furuncles. [aafp.org]

• Pneumonia

  herpes virus infection, herpes zoster, influenza, molluscum contagiosum Last Update: 2012-04-10 Usage Frequency: 2 Quality: Maltese Farinġite Rinite Pnewmonja Infezzjoni ta 'l- apparat respiratorju ta ’ fuq Follikulite English Pharyngitis Rhinitis Pneumonia [mymemory.translated.net]

  Bacterial folliculitis Complications of bacterial folliculitis Soft tissue infection Bacterial folliculitis can lead to cellulitis and lymphangiitis; subsequent bacteraemia might result in osteomyelitis, septic arthritis or pneumonia. [dermnetnz.org]

  £1,000,000 Payment: if you become critically ill and live for 10 days after diagnosis Health articles Keep on top of your health and wellbeing with our guides and articles. 6 Jul 2018 Protecting your lungs Ways you can keep your lungs healthy and help avoid pneumonia [aviva.co.uk]

• Arthritis

  Bacterial folliculitis Complications of bacterial folliculitis Soft tissue infection Bacterial folliculitis can lead to cellulitis and lymphangiitis; subsequent bacteraemia might result in osteomyelitis, septic arthritis or pneumonia. [dermnetnz.org]

  Hidradenitis suppurativa Pemphigus Psoriatic arthritis Scleroderma Rashes Learn about rash types, treatments, causes, symptoms, diagnosis, and prevention. [skincarephysicians.com]

  Keywords: pregnancy and psoriatic arthritis. Tell-tale symptoms of psoriatic arthritis include: a red scaly rash and swollen stiff and painful. [edenbio.eu]

  (Korean J Dermatol 2018;56(5):301∼307) 다운로드 (기관인증 필요) 초록보기 Background: Psoriatic arthritis (PsA) is a seronegative inflammatory arthritis associated with psoriasis. [kiss.kstudy.com]

  Psoriasis may increase your risk of developing certain diseases, such as: psoriatic arthritis obesity type 2 diabetes metabolic syndrome cardiovascular disease high blood pressure kidney disease Parkinson’s disease other autoimmune disorders, such as [healthline.com]

• Eruptions

  Neutrophilic folliculitis is an often overlooked chronic condition characterized by a monomorphic eruption of "sterile" papulopustules. [ncbi.nlm.nih.gov]

  The eruptions are graded by severity: Grade 1: macular-papular eruption or erythema without associated symptoms Grade 2: macular-papular eruption, erythema, or local desquamation covering less than 50% of body surface, associated with pruritus or other [dermatologyadvisor.com]

  EGFR inhibitor-induced papulopustular eruption. Figure 8. EGFR inhibitor-induced papulopustular eruption. Conclusion It's very important to study special types of folliculitis which can be differentiated from acne. [tandfonline.com]

• Skin Disease

  Try our skin disease search engine here To see more pictures of folliculitis [idoc24.com]

  Folliculitis due to inflammatory skin diseases Certain uncommon inflammatory skin diseases may cause permanent hair loss and scarring because of deep-seated sterile folliculitis. [dermnetnz.org]

  The disease may be a primary skin disease or a secondary disease to inflammatory dermatoses such as folliculitis and rosacea. Demodex spp. blepharitis is an infectious ocular disease that is common but always neglected. [ncbi.nlm.nih.gov]

  Skin diseases associated with Malassezia yeasts: facts and controversies. Clin Dermatol. 2013 Jul-Aug. 31(4):455-63. [Medline]. Gaitanis G, Magiatis P, Hantschke M, Bassukas ID, Velegraki A. The malassezia genus in skin and systemic diseases. [emedicine.medscape.com]

  People who live in crowded conditions, have poor hygiene or chronic skin diseases, or whose nasal passages contain Staphylococcus are more likely to have episodes of folliculitis or skin abscesses. [msdmanuals.com]

• Acne Vulgaris

  The history and pathophysiology of gram-negative folliculitis in the setting of acne vulgaris is reviewed. [ncbi.nlm.nih.gov]

  We discuss 6 patients with recalcitrant “acne” who had acne vulgaris and Pityrosporum folliculitis simultaneously. [jamanetwork.com]

  Deep- (usually granulomatous)- Fungi or bacteria II Non infectious- Superficial- (usually suppurative)- Acne vulgaris, rosacea, follicular mucinosis, steroid induced. [histopathology-india.net]

  […] and should be differentiated from acne vulgaris aggravated by sunlight. [tandfonline.com]

• Eczema

  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]

  Therefore, the possibilities of follicular eczema and follicular contact dermatitis were also considered as possible diagnoses for his condition. [cureus.com]

  Commonly Associated Conditions Impetigo Scabies Acne Follicular psoriasis Eczema Xerosis Staphylococcus/MRSA colonization There's more to see -- the rest of this entry is available only to subscribers. Citation Stephens, Mark B., et al., editors. [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]

• Pruritus

  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]

  Can occur anywhere on the body where hair is found Most frequent symptom is pruritus. [unboundmedicine.com]

  Causes intense pruritus, particularly in areas under a bathing suit [ 2, 3 ]. [patient.info]

• Genital Lesions

  Pimples or pustules may be seen located around a hair follicle, resembling the lesions of chicken pox. These pustules may gradually crust over and typically occur on neck, armpit, or groin. These lesions may also present as genital lesions. [xpertdox.com]

  Signs and symptoms[edit] 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]

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 [7]. Skin biopsy may sometimes be done to rule out other cutaneous disease conditions [8].

• Pseudomonas

  A clinical diagnosis of pseudomonas folliculitis was made and treatment was prescribed. Afterwards Pseudomonas aeruginosa was isolated from a pustule culture. Pseudomonas folliculitis is a bacterial infection of the hair follicles. [ncbi.nlm.nih.gov]

  Pseudomonas Folliculitis Pseudomonas folliculitis, also known as hot tub folliculitis, is a type of superficial folliculitis caused by the pseudomonas bacteria, which can become a problem in places where the pH levels are not always controlled, such as [healthyliving.azcentral.com]

  Pseudomonas aeruginosa and other Pseudomonas species. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. [medlineplus.gov]

  Pseudomonas folliculitis fact sheet, P-42079 Last Revised: March 28, 2017 [dhs.wisconsin.gov]

• Leukocytosis

  Laboratory abnormalities included eosinophilia (15.8%), abnormal liver function tests (7.9%), leukopenia (4.3%), an elevated serum creatinine level (2.2%), and leukocytosis (0.7%). [kiss.kstudy.com]

  CBC suggestive of leukocytosis and eosinophilia, with elevated immunoglobulin E levels in patients with eosinophilic folliculitis. RBS can be done in cases of the recurrent folliculitis. [wikidoc.org]

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 [9].

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:

• Inflammatory skin conditions like acne and dermatitis
• Skin incisions from surgery or scrapings
• Unhygienic coverings of the skin like old plaster dressing and adhesive tapes
• Sweating and heat caused by wearing booties, waders, and rubber gloves
• Friction from shaving and tight clothing

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 [1], and on chronic occlusive dressings. Folliculitis has been frequently observed among military personnel on the site of their anthrax and small pox immunizations [2].

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 [3], while the Japanese are more prone to the eosinophilic type of folliculitis [4]. 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 [5].

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 [10].

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.

Definition

Folliculitis is clinically defined as an active inflammation of one or more hair follicles found anywhere in the skin.

Cause

Any break in the integrity of the skin, and infected by bacteria, virus, and fungal etiologic agents.

Symptoms

Symptomatology ranges from red painless sore to an exudative blistering abscess.

Diagnosis

A complete clinical history and direct physical examination of the skin, skin swab for culture and sensitivity testing [11] 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.

1. Okada S, Fujimura T, Furudate S, Kambayashi Y, Kikuchi K, Aiba S. Immunosuppression-associated eosinophilic pustular folliculitis (IS-EPF) developing after Highly Active Anti-Retroviral Therapy (HAART): the possible mechanisms through CD163+ M2 macrophages. Eur J Dermatol. Sep-Oct 2013; 23(5):713-4.
2. Walsh SR, Johnson RP. Vaccinia Folliculitis after Primary Dryvax Vaccination. Infect Dis Clin Pract. Mar 2007; 15(2):132-4.
3. Fox GN, Stausmire JM, Mehregan DR. Traction folliculitis: an underreported entity. Cutis. Jan 2007; 79(1):26-30.
4. Nervi SJ, Schwartz RA, Dmochowski M. Eosinophilic pustular folliculitis: a 40 year retrospect. J Am Acad Dermatol. Aug 2006; 55(2):285-9.
5. Bragg J, Pomeranz MK. Papulopustular drug eruption due to an epidermal growth factor receptor inhibitors, erlotinib and cetuximab. Dermatol Online J. 2007; 13(1):1.
6. Boer A, Herder N, Winter K, Falk T. Herpes folliculitis: clinical, histopathological, and molecular pathologic observations. Br J Dermatol. Apr 2006; 154(4):743-6.
7. Weedon D, Strutton G. Skin Pathology. 2nd Ed. New York, NY: Churchill Livingstone; 2002:459-66.
8. Weinberg JM, Mysliwiec A, Turiansky GW, Redfield R, James WD. Viral folliculitis. Atypical presentations of herpes simplex, herpes zoster, and molluscum contagiosum. Arch Dermatol. Aug 1997; 133(8):983-6.
9. Satoh T, Shimura C, Miyagishi C, Yokozeki H. Indomethacin-induced reduction in CRTH2 in eosinophilic pustular folliculitis (Ofuji's disease): a proposed mechanism of action. Acta Derm Venereol. 2010; 90(1):18-22.
10. 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-
11. Nervi SJ, Schwartz RA, Dmochowski M. Eosinophilic pustular folliculitis: a 40 year retrospect. J Am Acad Dermatol. Aug 2006;55(2):285-9.