Description

• Inflammation of either superficial and/or deep hair follicle caused by infection, physical (traction) or chemical (tar/oils) irritation, or injury (1)

• Generally is an acute self-limiting disease that can occur anywhere on the body that hair is found.
• Clusters of pink/red raised bumps that are often pruritic, occasionally painful, and frequently embarrassing/worrisome
• Most commonly associated with infection by Staphylococcus aureus or Pseudomonas aeruginosa (in the case of “hot tub folliculitis”), but also can have fungal or viral cause
• Noninfectious types include:
  • Eosinophilic pustular folliculitis (Ofuji disease in patients of Asian descent)
  • Eosinophilic folliculitis (seen in HIV-positive/immunocompromised)
  • Folliculitis decalvans
  • Pruritic folliculitis of pregnancy
• Pseudofolliculitis barbae is similar in appearance and historical causality, but it is a distinct disease process affecting the curly type hairs on the face/neck of primarily black males.

Epidemiology

• Folliculitis is a common disorder; a majority of people have been affected at some point in their lifetime.
• Affects persons of all ages, gender, and race

Risk Factors

• Hair removal (shaving/waxing)
• Other skin conditions: Eczema, acne
• Occlusive dressing/clothing
• Personal carrier of/or contact with methicillin-resistant Staphylococcus aureus (MRSA)-infected persons
• Obesity
• Immunosuppression (medications, chemotherapy, HIV)
• Use of hot tubs or saunas
• Diabetes mellitus

General Prevention

• Good hygiene practices:
  • Frequent hand washing
  • Antibacterial soaps
  • Frequent washing in hot water of towels/linens to avoid reinfection from contaminated clothing and washcloths, etc.
• Minimize friction from clothing.
• Good hair removal practices:
  • Exfoliate beforehand.
  • Use witch hazel, alcohol, or TendSkin afterward.
  • Shave in direction of hair growth; use moisturizer/warm water; change razor frequently.
  • Decrease frequency of shaving.

Pathophysiology

Predisposing factors to folliculitis:

• Nasal carriage of S. aureus
• Exposure to (poorly chlorinated) pools/hot tubs leading to P. aeruginosa folliculitis
• Recent/Prolonged antibiotic or corticosteroid use leading to Candida folliculitis

Etiology

• Bacteria:
  • Staphylococcal infection
  • MRSA due to increasing incidence of community-acquired infections
  • Pseudomonal folliculitis commonly erupts quickly after soaking in an infected spa or hot tub.
• Fungal:
  • Pityrosporum/Malassezia folliculitis may mimic acne, as it causes folliculitis of chest, back, shoulders, face, scalp
  • Candida
• Viral:
  • Herpes simplex and Herpes zoster can cause folliculitis at the site/area of the herpes infection.
• Parasitic:
  • As a reaction to cutaneous larva migrans infestation
  • Demodex mite infection on the face and scalp
• Immunosuppression:
  • Transplant patients taking sirolimus are at risk for scalp folliculitis.
  • Eosinophilic folliculitis is uncommon in completely healthy adults, being more common in immunosuppressed (AIDS) patients, but in Japan it occurs as Ofuji disease.

Commonly Associated Conditions

• Conjunctivitis
• Impetigo
• Acne
• Eczema