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FOLLICULITIS

Folliculitis is a common skin condition characterized by inflammation of hair follicles which results in itchy, painful and red bumps. It is usually caused by bacteria or fungal infection and can affect the hair follicles present all over the body. This condition is more common in adults than in children.

Types of folliculitis:

Superficial folliculitis:  It is acute in onset and causes mild discomfort. Bacterial folliculitis, hot tub folliculitis (pseudomonas folliculitis), razor bumps (pseudofolliculitisbarbae), and folliculitis of the upper trunk (pityrosporumfolliculitis) are examples of superficial folliculitis.

Deep folliculitis: In this type, the patient will have long-standing painful lesions. Recurrent lesions may cause scarring and permanent hairloss. Examples of deep folliculitis include sycosis barbae, gram-negative folliculitis, boils and carbuncles, and eosinophilic folliculitis.

SIGNS AND SYMPTOMS

The signs and symptoms of folliculitis are as follows:

  • Clusters of small red bumps or white-headed pimples present around hair follicles
  • Pus-filled blisters that may break open and crust over
  • Large swollen bump or mass
  • Itchy, burning, painful and tender skin

 

This condition is generally observed in hairy areas of the body such as thebeard, face, scalp, armpits, thighs and inguinal regions.

CAUSES

Folliculitis is usually caused by bacteria, fungi, viruses and inflammation of ingrown hair. Other factors which may cause folliculitis include

  1. Shaving, plucking or waxing of hair which can irritate the hair follicle.
  2. Using greasy skin and hair products which clog the hair follicle and cause inflammation.
  3. Using medications such as coal tar products and topical steroids which may also cause skin irritation

RISK FACTORS

The following are the some of the risk factors for folliculitis.

  • Dermatological treatment with topical corticosteroids
  • Nasal infection caused by the bacteria Staphylococcus aureus
  • Excessive sweating
  • Skin abrasion, wound or abscess
  • Shaving 'against the grain'
  • Reduced immunity
  • Excessive humidity
  • Friction from clothing
  • Pre-existing dermatitis
  • Wearing tight clothing
  • Uncut beard
  • Decreased immunity

COMPLICATIONS

The following are the complications of folliculitis.

  • Development of furuncles (boils) and carbuncles (collection of boils under the skin)
  • Systemic illness secondary to spread of infection in immunocompromised patients
  • Keloid formation (benign growth of the scar tissue formed after the injury is healed)
  • Abscess formation (tender, soft swelling filled with pus)
  • Recurrence
  • Scarring

DIAGNOSIS

The doctor would first clinically examine the patient’s skin and discuss the medical history. The doctor may consider using a technique referred to as Dermoscopy which uses skin surface microscopy to examine the skin lesion. If the infection is severe, then a Skin swab may be taken to determine the cause of infection.

Skin biopsy is rarely done to rule out other conditions. A small amount of the affected skin tissue is removed and sent to laboratory for examination. The tissue is studied under the microscope to determine the pathological changes and to establish diagnosis.

TREATMENT

Folliculitis may be treated with self care measures, medications and laser hair removal. The choice of treatment is based on the severity of the condition.

Medication

A variety of medications are available for the treatment of folliculitis. The doctor may prescribe the following types of anti- fungal or anti-bacterial antibiotics based on the cause of infection:

  • Topical antibiotic creams to treat mild infections.
  • Oral antibiotics to treat severe and recurrentinfections.
  • Topical antifungal creams, antifungal shampoos and oral antifungals to treat infections caused by yeast or other fungi.
  • Steroid creams and oral corticosteroids to relieve itching caused in mild eosinophilic folliculitis.

Laser hair removal: The laser light is used to remove the hair follicles permanently to decrease the density of hair from the affected area. It may be associated with side effects such as scarring and blistering.

Minor surgery (lancing): The doctor may make incision and drain the pus from large boil or carbuncle and cover the area with cotton gauge after the surgery.

Self care measures and home remedies

The following are the some of the home remedies which may be helpful in relieving signs and symptoms of folliculitis.

  • Warm compresses: Compressing the affected area with cloth soaked in warm water relieves itching.
  • Over-the-counter products: Folliculitis can be managed with various over-the-counter creams, lotions, gels and washes available in market.
  • Good hygiene: Washing the affected area with mild soap twice a day can prevent infection.
  • Soothing bath: Warm water bath can relieve the pain and itching associated with folliculitis.
  • Skin protection: Avoiding tight clothes and preferring to trim instead of shaving can protect the skin from damage.

PREVENTION

Folliculitis can be prevented by the following ways:

  • Preventing skin from abrasions or irritations
  • Shaving the skin without any nicks and cuts
  • Using sterile shaving tools
  • Avoiding antiseptic washes
  • Changing sweaty clothes
  • Washing clothes regularly
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