Hair

Superficial Folliculitis

search

Superficial Folliculitis, Folliculitis, Staphylococcal Folliculitis

  • Pathophysiology
  1. Usually caused by Bacterial Infection
  2. Superficial inflammation of Hair Follicle
    1. Only upper Hair Follicle involved
    2. Contrast with Deep Folliculitis
  • Risk Factors
  1. Local Trauma
    1. Abrasion
    2. Surgical wounds or draining abscess
    3. Shaving
      1. Aggravates Staphylococcus aureus Folliculitis
  2. Exposure to Occlusive Dressing
    1. Tar
    2. Adhesive plaster
    3. Plastic Occlusive Dressings
  • Causes
  1. See Folliculitis
  2. Staphylococcal Folliculitis (most common)
    1. Affects beard area (Folliculitis barbae)
    2. Also affects axillae and legs
    3. Aggravated by shaving
  3. Pseudofolliculitis Barbae
  4. Superficial Fungal Infection
  5. Cutaneous Candidiasis (Candida albicans)
    1. Seen in febrile hospitalized patients
  6. Acne Vulgaris
  7. Keratosis Pilaris
  • Symptoms
  1. Non-tender or minimally tender
  2. Variably pruritic
  • Signs
  1. Characteristics
    1. Pustule confined to Hair Follicle
    2. Hair Shaft may be seen at center of lesion
    3. Yellow or gray coloration with erythema
  2. Distribution: Any skin bearing hair
    1. Head and neck
    2. Trunk
    3. Buttocks
    4. Extremities
  3. Absent features
    1. No associated fever or systemic symptoms
  • Differential Diagnosis
  1. Beard area Folliculitis
    1. See Beard Dermatitis
  2. Trunk Folliculitis
    1. Tinea Corporis (Ringworm)
    2. Pustular Miliaria
      1. Not perifollicular
      2. Occurs in hot, humid weather
  • Management
  1. General
    1. Eliminate provocative agents (tar, Mineral Oil)
    2. Keep affected areas clean
    3. Apply Mupirocin ointment to affected areas
    4. Consider warm, wet Burow's Solution
  2. Antibiotics
    1. Dicloxacillin 250-500 mg PO qid for 10 days
    2. Erythromycin 250-500 mg PO qid for 10 days
  3. Topical Corticosteroids
    1. Indicated for associated significant inflammation
  4. Prevention (Suppression of infection)
    1. Cleocin T after shaving
    2. Mupirocin (Bactroban) in nostrils
  • Course
  1. Heals without scarring
  • References
  1. Fitzpatrick (1992) Color Atlas Dermatology
  2. Habif (1996) Dermatology, p. 248-51
  3. Stulberg (2002) Am Fam Physician 66(1):119-24 [PubMed]