Follicle Disorders

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Overview

Folliculitis is infection and inflammation of the hair follicles. The condition may be superficial (i.e., on the surface of the skin) or deep within the follicles. Hair follicles become red and irritated, and pus-filled lesions form. Folliculitis can clear up by itself in a matter of a couple of weeks or become more persistent and thus require treatment.

Causes and Risk Factors

The most common cause of folliculitis is infection by the bacteria Staphylococcus aureus. Other species of bacteria may also be responsible. For example, contaminated water in whirlpools and hot tubs can transmit Pseudomonas aeruginosa, which can cause folliculitis. This bacterium may also be passed in wet suits.

Fungal and viral infections can also cause the condition. These are not common, but doctors may suspect these agents if conventional treatments do not work. Viral infections may be more common in those with compromised immune systems, such as AIDS, organ transplant, and cancer patients.

Folliculitis symptoms can appear independent of infection. Exposure of the skin to certain chemicals, especially oils and tars, can trigger an outbreak. People with depressed immune systems, diabetes, or obesity have a greater risk of contracting folliculitis than the general population.

Signs and Symptoms

An early sign of folliculitis is a small white or yellow pus-filled lesion (pustule) on a red, inflamed follicle. The most likely starting points are the scalp, thighs, legs, and buttocks.

When an infection of the follicle goes deeper, it becomes a boil or furuncle. A group of closely packed boils create a larger lesion called a carbuncle. These lesions tend to occur in hairy, sweaty areas of the body.

Treatment

Dermatologists usually treat mild cases of folliculitis with antiseptic washes combined with topical antibiotics. Tea tree oil, obtained from a health food store, is a good topical antiseptic as well. A small percentage of individuals may develop an allergy to it. Mild to moderate boils respond well to hot water compresses. In some cases, oral antibiotic treatment should accompany topical treatment. The antiobiotic chosen is determined by the cause suspected in an individual case. If lesions contain large quantities of pus or liquid, the doctor will drain them. This allows the antibiotics to penetrate to the affected areas.

Some stubborn cases of folliculitis have been responsive to laser-assisted hair removal. This process uses a laser to destroy the follicle. This reduces the scarring that results from folliculitis. However, hair will no longer grow in the treated area.

Patients with chronic unresponsive folliculitis may require investigation into the source of the infection. S. aureus bacteria can live in the patient's nostrils, periodically triggering a folliculitis outbreak. Sometimes the bacteria colonize the nostrils of a family member who does not develop the disorder but repeatedly reexposes the patient to the microbe. To break the patient's cycle of recurrence, the family member must also undergo treatment.

Follow-Up Treatment
Because of the recurrent nature of follicle disorders, it is essential that patients receive adequate follow-up care. The dermatologist may be able to recognize a recurrence before it becomes severe.

Prevention

Individuals who are predisposed to folliculitis should be extremely careful about personal hygiene. Application of antiseptic washes may help prevent recurrences. A topical antibiotic cream, mupirocin (Bactroban®), has been effective at reducing bacterial colonization in the nostrils. It is applied twice daily for a week and is repeated every 6 months.

An individual who is frequently exposed to oil, tar, or other irritating chemicals should avoid those substances or wear protective gear. Patients with diabetes, obesity, or compromised immune systems should be aware of folliculitis as a possible consequence of their disorder.

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