Folliculitis

Question 1

What is folliculitis?

Answer 1

Folliculitis means an inflamed hair follicle due to any cause. The result is a tender red spot, often with a surface pustule.

Question 2

Where can folliculitis be found?

Answer 2

Folliculitis may be superficial or deep. It can affect anywhere there are hairs, including chest, back, buttocks, arms, and legs. Acne and its variants are also types of folliculitis.

Question 3

What causes folliculitis?

Answer 3

1. Infection (Most common)
2. Occlusion
3. Irritation
4. Various skin diseases

Question 4

What is bacterial folliculitis usually caused by?

Answer 4

Staphylococcus aureus

Question 5

What happens if the infection involves a deep part of the follicle?

Answer 5

A painful boil results

Question 6

Name two non-infectious types of folliculitis:

Answer 6

1) Eosinophilic folliculitis
2) Folliculitis decalvans

Question 7

How does eosinophilic folliculitis present?

Answer 7

itchy, red bumps centred on hair follicles typically on the upper body, sparing the legs

Question 8

What disease is a major risk factor for eosinophilic folliculitis?

Answer 8

HIV

Question 9

What is folliculitis decalvans?

Answer 9

rare, chronic inflammation of scalp hair

Question 10

Describe the presentation seen in folliculitis decalvans?

Answer 10

itching, redness with pustular discharge resulting in alopecia and scarring

Question 11

Describe the general presentation seen in folliculitis:

Answer 11

erythematous papules or pustules found around the hair follicles

Question 12

Where is folliculitis most commonly found? (3)

Answer 12

in areas with terminal hair growth such as
1) head and neck
2) axillae
3) groin and buttocks

Question 13

Give 5 risk factors for folliculitis:

Answer 13

1) shaving and hair extraction
2) using hot tubs
3) diabetes or immunosuppression
4) hyperhidrosis
5) steroid cream use

Question 14

What is the name given to chronic folliculitis of the beard area in men?

Answer 14

sycosis barbae

Question 15

What is sycosis barbae?

Answer 15

chronic crusted and painful skin in the beard area of the face

Question 16

What bacteria causes hot tub/ Spa folliculitis?

Answer 16

Pseudomonas aeruginosa

Question 17

What is the most common yeast to cause folliculitis?

Answer 17

Pityrosporum ovale, also known as Malassezia.

Question 18

What is Malassezia folliculitis?

Answer 18

is an itchy acne-like condition usually affecting the upper trunk of a young adult.

Question 19

How would you manage and treat malassezia folliculitis?

Answer 19

Treatment includes avoiding moisturisers, stopping any antibiotics and using topical antifungal or oral antifungal medication for several weeks.

Question 20

What does candid albicans provoke?

Answer 20

a folliculitis in skin folds (intertrigo) or the beard area. It is treated with appropriate topical or oral antifungal agents.

Question 21

What contact/irritants may cause folliculitis?

Answer 21

1. Shaving/Waxing
2. Occlusion via moisturisers, plasters etc
3. Chemicals such as coal tar, cutting oils
4. over use of Topical steroids

Question 22

Name 4 inflammatory diseases that involve folliculitis?

Answer 22

1. Lichen planus
2. Discoid lupus erythematous
3. Folliculitis decalvans
4. Folliculitis keloidalis

Question 23

Name 5 acne variants of folliculitis?

Answer 23

1. Acne vulgaris
2. Nodulocystic acne
3. Rosacea
4. Scalp folliculitis
5. Chloracne

Question 24

Define superficial folliculitis.

Answer 24

many cases of folliculitis are very mild, superficial, self-limiting and of little clinical importance. Patients with superficial folliculitis usually present with multiple small papules and pustules on an erythematous base that are pierced by a central hair, although the hair may not always be visualised

Question 25

Define deep folliculitis.

Answer 25

deeper lesions manifest as painful, erythematous, often fluctuant, nodules and may have suppurative drainage. Persistent or recurrent lesions may result in scarring and permanent hair loss. When deep-seated folliculitis occurs on the beard areas of the face it is referred to as sycosis barbae, when it occurs elsewhere it is referred to as a furuncle or carbuncle

Question 26

What is a furuncle?

Answer 26

is a deeper, and more pronounced infection of the hair follicle in which purulent material extends through the dermis into the subcutaneous tissue, where a small abscess forms.

Question 27

what is a carbuncle?

Answer 27

is a coalescence of several inflamed follicles into a single inflammatory mass with purulent drainage from multiple follicles

Question 28

What factors cause malassezia folliculitis?

Answer 28

The yeast tends to overgrow in hot, humid environments. Sweating can also be encouraged by wearing occlusive clothing, sunscreens and greasy emollients, which may occlude the follicles
Patients with Down’s syndrome appear to be at an increased risk
Oily skin, obesity, pregnancy, systemic illness (eg diabetes mellitus, immunodeficiency), broad spectrum oral antibiotics (often prescribed for acne), and prednisolone are also risk factors

Question 29

What investigations are carried out for folliculitis?

Answer 29

1. Skin swabs
2. Nasal swabs - folloculitis barbae
3. Blood screen - recurrent carbuncles and furuncles
4. Screen for HIV - eosinophillic folliculitis

Question 30

What patients are at particular risk of Gram negative folliculitis?

Answer 30

patients treated with long term antibiotics for acne

Question 31

What is another name for pseudo-folliculitis?

Answer 31

razor bumps

Question 32

What causes pseudo-folliculitis?

Answer 32

ingrowing hairs

Question 33

What type of hair increases risk of pseudo-folliculitis?

Answer 33

curly or Afro Caribbean hair

Question 34

Give 3 general medications used to manage folliculitis (based on cause and severity):

Answer 34

1) emollients
2) fusidic acid
3) oral antibiotics