Folliculitis

Definition/diagnostic criteria Folliculitis is inflammation of the hair follicles, typically manifesting as small, red, sometimes pus-filled bumps on the skin. It can be due to infection, physical injury, chemical irritation or an unknown cause. The condition is often divided into superficial and deep forms, depending on the extent of follicular involvement. The most common causative pathogen is Staphylococcus aureus.

Epidemiology Folliculitis affects individuals of all ages, races and genders. It is prevalent worldwide and can affect any area of the skin with hair growth. The exact incidence and prevalence are unknown, but superficial folliculitis (e.g., bacterial folliculitis) is commonly encountered in general practice. Risk factors include occlusive clothing, poor hygiene, pre-existing dermatological conditions and immunocompromised states.

Diagnosis
Clinical features: Folliculitis presents as clusters of small red bumps or white-headed pimples that surround hair follicles. The lesions may be painful or itchy and can occur anywhere on the body. In superficial forms, the surrounding skin might be reddened with no scarring, whereas deep folliculitis can cause scarring and permanent hair loss. Pustules, erythema and mild tenderness are typical findings on examination. One particular form that tends to be persistent and affects the beard area in men is known as sycosis barbae.

Investigations: Diagnosis is primarily clinical. Occasionally, swabs should be taken from pustular lesions to identify the causative organism, especially if recurrent or if systemic symptoms are present. Dermoscopy can help differentiate from other follicular conditions. For recurrent or resistant cases, further investigations to exclude predisposing factors such as diabetes or immunodeficiency might be necessary.

Treatment Treatment aims to reduce inflammation, eradicate the infection and address any underlying causes. Mild cases may resolve spontaneously. General measures include advising patients to avoid shaving and tight clothing over the affected area and to maintain good skin hygiene.

• For bacterial folliculitis, topical antiseptics or antibiotics such as fusidic acid or mupirocin can be used.
• For more severe or extensive cases, a course of oral antibiotics such as flucloxacillin or erythromycin is recommended.
• Chronic or severe cases might require antifungal treatment, if caused by fungal organisms, or long-term antibiotic therapy.
• Sycosis barbae may be helped by topical antiseptics or steroids, stopping shaving altogether or using an electric razor and leaving a short stubble.
• If the condition is non-infectious, treatment involves managing the underlying cause, such as stopping any offending irritant or treating any associated dermatosis.

Prognosis The prognosis for folliculitis is generally good, especially for superficial forms. Most episodes of bacterial folliculitis resolve without scarring or complication if treated appropriately. However, recurrence is common, and chronic or deep folliculitis can lead to complications such as scarring and permanent hair loss. Patient education on skin care and avoidance of risk factors is crucial in preventing recurrences.