​Kembara Xtra - Medicine - Folliculitis

​Kembara Xtra - Medicine - Folliculitis 

Introduction 
A condition that causes inflammation of a hair follicle. Perifolliculitis and pseudofolliculitis are two subtypes of folliculitis that manifest themselves surrounding the hair follicle.
Capable of developing in any part of the body that possesses hair.
● Most frequent symptom is pruritus.
Pustules, vesicles, or pink or red papulopustules up to 5 mm in size; lesions may or may not be tender. Infection is the most prevalent cause of this condition. - Bacteria known as Staphylococcus aureus
Pseudomonas aeruginosa can infect parts of the body that have been in contact with pools, hot tubs, or other bodies of water that have not been adequately sterilized.
- Aeromonas hydrophila associated with exposure to recreational water
- Fungal (dermatophytic, Pityrosporum, Candida) - Viral (VZV, herpes simplex virus [HSV])
- Infectious (schistosomes, Demodex species, and other types of mites)
Varieties that do not spread disease
Acne vulgaris, Acneiform folliculitis, Actinic superficial folliculitis, Keloidal folliculitis, Folliculitis decalvans, Perioral dermatitis, Fox-Fordyce disease, Pruritus folliculitis of pregnancy, and Eosinophilic pustular folliculitis (three variants: Ofuji disease in patients of Asian descent, HIV positive/immunocompromised – Eosinophilic folliculitis, which is observed in HIV-positive and immunocompromised patients – Toxic erythema of the newborn
- Follicular mucinosis Skin conditions that may result in a follicular eruption include the following: - Pseudofolliculitis barbae: has a similar appearance; develops after shaving; is more common in black men and is referred to as razor bumps. – Seborrheic dermatitis – Folliculosclerotic psoriasis – Rosacea –
EPIDEMIOLOGY
Affects people of all ages, both sexes, and all races, with people of African ancestry being more susceptible to particular forms of folliculitis.

Causes and effects: etiology and pathophysiology 
Folliculitis risk factors include being a chronic staphylococcal carrier, having diabetes mellitus, being malnourished, having a pruritic skin illness (such as scabies or eczema), and being exposed to improperly chlorinated swimming pools or hot tubs or water that is polluted with P. aeruginosa, A. hydrophila, or schistosomes.
Prolonged usage of occlusive corticosteroids (for several hours at a time)
Bacteria – Most commonly due to Staphylococcus aureus (growing number of methicillin-resistant Staphylococcus aureus [MRSA] cases) – Also due to Streptococcus species, Pseudomonas (after exposure to water polluted with the species), or Proteus – Usually caused by S. aureus (increasing number of methicillin-resistant Staphy Possible progression to furunculosis, a painful pustular nodule with core necrosis that, once healed, leaves a permanent scar.
● Fungal
– Dermatophytic (tinea capitis, tinea corporis, tinea pedis)
– Pityrosporum (Pityrosporum orbiculare) commonly
affecting teenagers and men, predominantly on upper
chest and back – Candida albicans, although rare, has
been reported with broad-spectrum antibiotic use,
glucocorticoid use, immunosuppression, and in those
who abuse heroin, resulting in candidemia that leads to
pustules and nodules in hair-bearing areas.
Acneiform type commonly caused by drug induction (systemic and topical corticosteroids, lithium, isoniazid, rifampin), EGFR inhibitors Severe vitamin C deficiency, scurvy
Within twenty-four to forty-eight hours of sun exposure, the actinic superficial type might appear, which is characterized by numerous follicular pustules on the trunk, shoulders, and arms.
Keloidal folliculitis is a chronic disorder that affects predominantly black individuals; it involves the neck and occipital scalp, resulting in hypertrophic scars and hair loss; it is typically the outcome of untreated folliculitis barbae. Acne vulgaris is the most common form of the condition.
Folliculitis decalvans is a persistent form of folliculitis that can eventually result in the loss of hair and gradual scarring of the scalp.
Rosacea is characterized by papules, pustules, and/or telangiectasias on the face. Individuals with rosacea have a genetic predisposition to develop the condition. Rosacea is sometimes confused with folliculitis.
Symptoms of Fox-Fordyce illness include chronic itching, annular papules, and follicular papules. This condition affects areas of the skin that contain apocrine sweat glands (i.e., the axillae).
There are three different forms of eosinophilic pustular folliculitis: the traditional form (Ofuji disease), the one associated with HIV infection, and the infantile form.
Toxic erythema of the newborn is a self-limiting pustular eruption that often manifests itself during the first three to four days of a newborn's life and then gradually disappears over the course of the succeeding two weeks.

 Infections caused by Malassezia in adult males that have lesions on the trunk

Other pruritic skin conditions: eczema, scabies; occlusive dressing or clothing; sweating; personal carrier or contact with MRSA-infected persons; diabetes mellitus; immunosuppression (medications, chemotherapy, HIV); use of hot tubs or saunas; use of EGFR inhibitors; chronic antibiotic use (gram-negative folliculitis); tattoo recipient; hair removal (shaving, plucking, waxing, epilating agents 


Preventive Measures in General 

 Methods of proper sanitation and hygiene
- Use antibacterial soap to wash your hands on a regular basis.
To prevent a recurrence of the infection, it is recommended that towels, clothing, and linens be washed as regularly as possible in hot water.
Proper methods for the removal of hair
- Start by exfoliating your skin.
Afterward, you can treat your skin with witch hazel, alcohol, or Tend Skin.
- Use shaving gel and moisturizer, and shave in the same direction that the hair grows.
Reduce the number of times each week that you shave.
– If you prefer a straight shave, you should mostly use clippers or a razor with a single blade.

Conditions such as impetigo, scabies, acne, follicular psoriasis, eczema, and xerosis, as well as staphylococcus and MRSA colonization, are associated with this infection.

Recent usage of hot tubs, swimming pools, topical corticosteroids, specific hair style and shaving habits, antibiotics, or systemic steroids may be a contributing factor in the diagnosis.
HIV status History of STDs (particularly syphilis) MRSA exposures / carrier status Home and work environment (risk / exposure potential) Pityrosporum folliculitis is more common in warm and damp climates MRSA exposures / carrier status  Inquire about the sequence of events that led up to the lesions, including any past incidents that were comparable.


The Patient's Clinical Examination 
Lesions that are characteristic include vesicles, pustules, or inflammatory papules that are between 1 and 5 mm diameter and are surrounded by erythema.
Pseudomonal folliculitis manifests itself as a widespread rash, primarily on the trunk and limbs. In pseudofolliculitis barbae, the growing hair curls around and enters the skin at shaved places. Rash occurs on hair-bearing skin, especially the face (beard), proximal limbs, scalp, and pubis.

Differential Diagnosis Acne vulgaris/acneiform eruptions Arthropod bite Contact dermatitis Perioral dermatitis Cutaneous candidiasis Milia Atopic dermatitis Follicular psoriasis Hidradenitis suppurativa Milia Cutaneous candidiasis Cutaneous candidiasis Cutaneous candidiasis Cutaneous candidiasis

Results From the Laboratory 
Initial Tests (lab, imaging)
A clinical diagnosis may be made after taking into consideration risk factors, previous medical history, and the sites of lesions.
When dealing with bigger lesions, lancing or unroofing the pustule and doing a Gram stain may be necessary.
a KOH preparation in conjunction with fluorescence from a wood lamp in order to diagnose Candida or yeast 
Tzanck smear in cases when there is a strong likelihood that herpes simplex viral folliculitis is present. Ultrasound in cases where it is unclear whether deeper seeded infections are present.


Additional Examinations, as well as Other Important Factors
Consider getting serologies for HIV or syphilis if there are any risk factors or clinical suspicions present.

If the symptoms keep coming back, you should get tested for HIV and have your A1C and fasting blood sugar checked to rule out diabetes.

If the diagnosis is questionable, you should consider getting a punch biopsy.
sensitivity should be taken into account while treating positive bacterial cultures.
In the case of a positive HIV serology, further testing should include a CD4 count and a punch biopsy to eliminate the possibility of eosinophilic folliculitis.

In most cases, the lesion will heal on its own without medical intervention.
TID: warm compresses may be used to the affected regions. TID: shaving and waxing the affected areas should be avoided.

Antibiotics that are administered systemically are rarely required.
It is possible to treat a suspected infection with S. aureus with topical mupirocin.

Fungal folliculitis can be treated with topical antifungals. Preventive interventions include:
– Bleach baths (1/2 cup of 6% bleach per standard bathtub and soak for 5 to 15 minutes followed by water, rinse 1 to 2 times a week) – Antibacterial soaps (Wash with Dial soap, chlorhexidine, or benzoyl peroxide when showering or bathing) – Bleach baths (1/2 cup of 6% bleach per standard bathtub and soak for 5 to 15 minutes followed by water, rinse 1 to 2 times a week) - Preserve the integrity of the skin, practice regular skin care with moisturizers that do not cause comedones, and refrain from scratching.
- To prevent further damage to the skin, always use an electric razor.
- Clean your razor and other shaving implements every day, or use a disposable razor and throw it away after each use.
Every day, you should change your washcloths, towels, and linens.

Medication 
In most cases, antiseptic treatment and supportive care are all that is required. Systemic antibiotics are a treatment option, however their effectiveness is debatable.

Mupirocin ointment should be applied twice daily for ten days in order to treat Staphylococcal folliculitis; cephalosporin (cephalexin) should be taken between 250 and 500 milligrams orally three times daily for seven to ten days; dicloxacillin should be taken between 250 and 500 milligrams orally three times daily for seven to ten days. Bactrim DS should be taken between one and two tablets (160
– Minocycline: 200 mg PO initially and then 100 mg BID
for 5 to 10 days – Doxycycline: 50 to 100 mg PO BID for
5 to 10 days
● Pseudomonas folliculitis – Topical dilute acetic acid baths
– Ciprofloxacin: 500 to 750 mg PO BID for 7 to 14 days
only if patient is immunocompromised or lesions are
persistent
● Eosinophilic folliculitis/eosinophilic pustular
folliculitis – HAART treatment for HIV-positive–related
causes. Take into consideration the possibility of referral to an appropriate treatment center.
Antihistamines (hydroxyzine, cetirizine) to decrease itching and anti-inflammatory high-potency topical corticosteroids for the treatment of inflammation
– Fungal folliculitis – Topical antifungals: ketoconazole 2% cream or shampoo or selenium sulfide shampoo daily or – Econazole cream given to afflicted area BID for 2 to 3 weeks.
 Fluconazole (100 to 200 mg/day for 3 weeks), itraconazole (200 mg/day for 1 week), or griseofulvin (500 mg/day for 2 to 4 weeks) are the systemic antifungals that are recommended for relapses. Because of the potential for liver failure, oral ketoconazole should not be used.
Apply 5% permethrin to the afflicted region, leave it on for eight hours, and then wash it off. This treatment is for parasitic folliculitis.
- Oral administration of Ivermectin at a dose of 200 micrograms per kilogram, with a subsequent dose 1–2 weeks later in the event that topical treatment is ineffective.
Valacyclovir: 500 mg PO TID for 5 to 10 days or Famciclovir: 500 mg PO TID for 5 to 10 days or Acyclovir: 200 mg PO 5 times daily for 5 to 10 days Herpetic folliculitis: Valacyclovir: 500 mg PO TID for 5 to 10 days or Famciclovir: 500 mg PO TID for 5 to 10 days


Referral 

Cases that are unusual or persistent ought to be biopsied, and then they ought to be sent to dermatology.

Extra Treatments and Medications 
Always be sure to stay informed: testing strips can be utilized in both swimming pools and hot tubs. This will assist in determining the appropriate quantities of chlorine.
● The pH level of the water in pools and hot tubs should be between 7.2 and 7.8.

Surgical Methods and Operations 

It is quite unlikely that incision and drainage will be required, and in most cases, these procedures are avoided because of the risk of scarring.

Continued Patient Observation and Monitoring

Cases that are resistant to treatment should be monitored every two weeks until they are cleared.
If the patient's condition is deteriorating, immediate system therapy should be considered.
DIETING Patients who are obese should have their caloric intake monitored; losing weight will lower the risk of skin damage and distension.


Avoid shaving in the affected regions and keep an eye on the spa and swimming pool.


The prognosis is that the infection will typically clear up after treatment; however, people who have the S. aureus bacteria strain may experience relapses.
It is possible that a nasal treatment with mupirocin might be beneficial for determining carrier status as well as for other members of the home or family.
Diabetes mellitus and human immunodeficiency virus (HIV) tests may be necessary for patients with resistant or severe cases.

Complications The most common complication is recurring folliculitis. Other complications include extensive scarring and hyperpigmentation, progression to furunculosis or abscesses, and hyperpigmentation.

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