Folliculitis
Elizabeth Austin
Leland S. Rickman
BasicsDescription
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Infection of hair follicles usually caused by Staphylococcus aureus
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May be caused by gram-negative organisms, as in the case of “hot tub” folliculitis
Epidemiology
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Lesions usually occur on areas of skin traumatized by maceration occurring under shoulder pads or sweaty garments.
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May develop on the legs, arms, and trunk of wrestlers
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Infection does not spread in epidemic proportions but may be transmitted through skin trauma.
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“Hot tub” folliculitis is associated with the use of hot tubs, whirlpools, Jacuzzis, and swimming pools.
Risk Factors
Furuncles occur in skin areas containing hair follicles subject to friction and perspiration.
Commonly Associated Conditions
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Deep folliculitis lesions ultimately may produce furuncles or boils.
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Boils may combine to form a large, exquisitely painful group of furuncles called a carbuncle.
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Furunculosis, an infection pertaining to hair follicles, sebaceous glands, or skin compromised by abrasions, wounds, or burns, may arise from existing areas of folliculitis.
DiagnosisHistory
Maceration caused by sports equipment is a common cause of folliculitis. This knowledge may lead to a definitive diagnosis.
Differential Diagnosis
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Folliculitis lesions consist of small (2–5 mm) erythematous, sometimes pruritic papules often topped by a central pustule.
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Cultures (if taken) will show the presence of S. aureus (or Pseudomonas aeruginosa for suspected “hot tub” folliculitis).
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Furuncles appear as deep, inflammatory nodules.
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Carbuncles extend into the subcutaneous fat; multiple abscesses are separated by connective tissue septa.
P.165
Treatment-
Acute treatment
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Mild folliculitis:
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Most cases of mild folliculitis heal spontaneously within 5 days.
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To prevent furuncle formation, astringent lotions or drying agents that remove the tops of pustules can be used.
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“Hot tub” folliculitis is self-limiting and lasts only 7–10 days. It requires no specific treatment other than avoiding persistent hot tub use.
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Furuncle or carbuncle formation:
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Aspiration or incision and drainage may be required for fluctuant lesions.
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Cleanse affected area with benzoyl peroxide.
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Oral antibiotics may be prescribed, but usually no more than 14 days of use are necessary to prevent recurrence. Agents effective against S. aureus include penicillinase-resistant penicillins such as oral dicloxacillin, cephalexin, and erythromycin (or other macrolides). Fluoroquinolones such as moxifloxacin, levofloxacin, and gatifloxacin may be effective.
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Warm compresses can be applied.
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Clothing and dressings that have come in contact with the affected area should be cleansed daily at high temperatures.
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Hand-washing should be performed regularly by all who come into contact with the affected area.
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Additional Reading
Adler AI, Altman J. An outbreak of mud-wrestling-induced pustular dermatitis in college students. Dermatitis palaestrae limosae. JAMA. 1993;269:502–504.
Bartlett PC, Martin RJ, Cahill BR. Furunculosis in a high school football team. Am J Sports Med. 1982;10:371–374.
Chandrasekar PH, Rolston KV, Kannangara DW et al. Hot tub-associated dermatitis due to Pseudomonas aeruginosa. Case report and review of the literature. Arch Dermatol. 1984;120:1337–1340.
Decker MD, Lybarger JA, Vaughn WK et al. An outbreak of staphylococcal skin infections among river rafting guides. Am J Epidemiol. 1986;124:969–976.
Heeb MA. Deep soft tissue abscesses secondary to nonpenetrating trauma. Surgery. 1971;69:550–553.
Minooee A, Rickman LS. Transmission of infectious diseases during sports. In: Scholssberg D, ed. Infections of leisure, 2nd ed. Washington, DC: American Society for Microbiology, 1999.
Sosin DM, Gunn RA, Ford WL, et al. An outbreak of furunculosis among high school athletes. Am J Sports Med. 1989;l:828–832.
Stevens DL. Cellulitis, pyoderma, and other skin and subcutaneous infections. In: Armstrong D, Cohen J, eds. Infectious diseases, vol. 1. St. Louis: Mosby/Harcourt Publishers, 1999:2.2.3–2.2.4.
Swartz NN. Cellulitis and subcutaneous tissue. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's principles and practice of infectious disease, vol. 1, 5th ed. Philadelphia: Churchill Livingstone; 2000.
CodesICD9
704.8 Other specified diseases of hair and hair follicles
Clinical Pearls
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Personal contact rarely causes transmission of S. aureus from a patient with folliculitis, but cases of transmission through skin trauma have been documented.
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Infected areas should be kept clean and covered. To prevent spread of infection, athletes with furuncles or carbuncles should be strongly discouraged from participation in contact sports until lesions have resolved.