Folliculitis

Folliculitis is an inflammation of the hair follicle. This is a common benign skin lesion. More severe forms may occur in patients with weakened immune systems.

Risk factors:

Folliculitis can be triggered by certain risk factors. Most can be prevented or reduced by lifestyle changes. These factors include:

• • carriage of S. aureus in the nasopharynx
  • follicular closure (e.g. using inappropriate skincare products)
  • sweating
  • digging
  • taking glucocorticoids (hormones)
  • shaving against the direction of hair growth

Causes and classification of the disease

Folliculitis can be divided into superficial and deep. Superficial can be infectious or non-infectious.

Infectious :

• • bacteria: S. aureus, Pseudomonas spp.
  • fungi: dermatophytes, Malassezia spp., Candida spp.
  • Herpes simplex, Varicella zoster
  • parasites: Demodex mites

Deep folliculitis is more finely dissected:

• • furunculus
  • sycosis (folliculitis barbae)
  • pseudofolliculitis barbae (beard pseudofolliculitis)
  • acne keloidalis

Clinical signs

Folliculitis is characterised by skin lesions:

• rash: pustules (abscesses) and papules (palpable bumps on the skin)
  • • related to the hair follicle
    • may itch
    • may be painful
    • hypo/hyperpigmentation, scarring of the skin may remain after recovery
    • may progress to furuncle, an inflammation of deeper tissues
• localisation of lesions: face, beard, scalp, waist, buttocks, legs

Diagnostics

The diagnosis of folliculitis is based on medical history and clinical data. In rare cases, additional tests may be needed to confirm the diagnosis, when history and clinical data are insufficient:

• KOH microscopy – for suspected folliculitis caused by fungi or Demodex
• microscopic examination, culture – if bacterial folliculitis is suspected
• PCR – for suspected viral folliculitis

Treatment

The treatment of folliculitis is based on the causative agent. Common treatments: removal of risk factors and use of antiseptics (Octenicept, Octenisan).

Specific treatment:

• • bacterial – local or systemic antibiotics
  • viral – local or systemic antivirals (acyclovir)
  • of fungal origin – topical or systemic antifungal drugs
  • demodex parasitic origin – local or systemic (ivermectin)

Advice and prevention

For folliculitis, it is advisable to consult a dermatovenereologist, especially if the rashes are widespread or if the symptoms persist for several days. After the consultation, it is essential to follow exactly the treatment prescribed by your doctor.

To prevent folliculitis it is advisable to:

• avoid tight, chafing clothing
• wash reusable cloth gloves
• avoid shaving or shave carefully, change blades, choose the right tools
• use only clean hot tubs, swimming pools