Folliculitis of the head, face, legs and groin

Literally, the name "folliculitis" means inflammation of the follicle - that is, the hair follicle. This disease belongs to the category of purulent pathologies: it is acute and manifests itself in the appearance of reddish pustules, gradually turning into abscesses with yellowish-greenish contents inside. Folliculitis lesions, as a rule, hurt and cause a lot of discomfort to the patient.

Folliculitis can have various etiologies, according to which the doctor determines the treatment of the disease.

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Epidemiology

Most patients with inflammation of the follicles are residents of countries with hot and humid climates. In addition, the disease is diagnosed mainly due to non-observance of sanitary and living conditions.

The disease may have a strictly professional origin: for example, it affects people who are in constant contact with chemicals, detergents, petroleum products, and lubricants.

There are no exact statistics on the incidence rate, as many patients do not seek medical attention for this problem and practice self-medication. Unfortunately, dermatologists have to start treatment when the disease becomes complicated: lymphadenitis, abscess, etc. occur.

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Causes folliculitis

Folliculitis can develop for many reasons. Often, this type of purulent inflammation appears when hygienic norms and rules are ignored, and various microdamages and maceration of the skin create a favorable background for infection to enter the tissue.

In addition, the disease can occur simultaneously with an existing weakness of the immune system - for example, immediately after an infectious disease or severe cooling of the body.

Inflammation of the follicles is not uncommon in cases of liver dysfunction, poor nutrition, and diabetes.

If the patient suffers from itchy skin, the risk of infection getting inside the follicle increases. Bacteria get deep into the tissues through scratches and combs. The situation is aggravated if the patient has increased sweating.

Particular suppression of local immune defense occurs with prolonged or chaotic use of hormonal ointments and creams.

Among the professional causes of the disease, one can name frequent contact of technical liquids, fuel oil, and chemical reagents with skin areas.

Malassezia is the cause of folliculitis

Malassezia is a yeast-like fungus that can be isolated from the skin of a healthy person, as it is considered a normal component of the flora. However, this fungus is often the cause of certain diseases called malasseziosis. These include seborrheic dermatitis and psoriasis, facial and cervical atopic dermatitis, versicolor lichen, folliculitis.

The disease begins against the background of an increase in the number of fungal colonies on the skin, or against the background of an inflammatory process with normal fungal colonies.

The inflammatory process occurs:

• in the development of hypersensitivity to the protein component of fungal cells;
• with increased production of metabolic products of fungal cells;
• with impaired fat metabolism in the skin.

Malassezia folliculitis is classified in an infectious group along with pityriasis versicolor, neonatal pustulosis and otitis.

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Risk factors

Folliculitis is considered an infectious pathology that can occur not only under the influence of microbes, but also viruses or fungi. However, an infectious invasion alone is not enough for the development of the disease: the main role is played by the creation of favorable conditions for the development of the inflammatory process. Therefore, certain risk factors are of no small importance.

Such factors can be external and internal.

External factors include:

• microdamage to the skin;
• dirty, greasy or sweaty skin surface;
• excessively tight or dense clothing, mainly of synthetic composition, as well as bandages, plasters, bandages, etc. that are not removed for a long time;
• hot climate, high humidity;
• hypothermia.

Internal factors include:

• low hemoglobin level;
• endocrine disorders, obesity, diabetes;
• improper nutrition (excess of salt, fats and/or carbohydrates in food, predominantly dry food);
• liver disease;
• local treatment with hormonal ointments, as well as oral administration of hormonal drugs or immunosuppressants.

Secondary folliculitis can be a consequence of diseases of the oral mucosa and teeth, chronic pathologies of the ENT organs. In principle, almost any disease that leads to a sharp decline in the quality of immune protection can cause the development of folliculitis.

• Folliculitis after sugaring / folliculitis after depilation is one of the complications of the procedure if it is performed incorrectly or if the skin is overly sensitive. In most cases, such development of folliculitis is a consequence of ingrown hairs: after the hair is removed, the skin becomes denser, and the newly grown hair, on the contrary, becomes thinner. As a result, the new hair cannot overcome the skin barrier, it changes the direction of growth and begins to grow in the opposite direction - deep into the skin. Damage to such an area invariably leads to the development of folliculitis and pustules.
• Folliculitis after shaving occurs both after hair grows into the skin and after using a razor with a dull blade. Often the cause is improper shaving, when the hair is shaved against its growth. This causes microdamage to the skin in places where the hair comes out, which becomes a favorable environment for infection.
• Folliculitis after Elokom ointment or other hormonal drugs appears if the drug is used for a long time, or chaotically, without indications and a specific treatment regimen. Hormonal ointments are often used to treat psoriasis, eczema, dermatoses, lichen, atopic dermatitis. However, such ointments are sold without a prescription, so there are often cases of self-administration of the drug without consulting a doctor. It is in such patients that drug-induced folliculitis most often develops. Advice: any treatment must be agreed with a doctor.

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Pathogenesis

Folliculitis is a dermatological pathology that is classified as a superficial pyoderma (pustular disease).

With folliculitis, the superficial areas of the hair follicles become inflamed, and the inflammation is infectious in nature.

How does the process develop? First, a papule is formed in the area of the follicular opening. Then the papule transforms into a pustule, in the center of which there is a hair. After this, a crust appears on the surface of the follicle.

If the process does not end there and spreads deep into the tissues, affecting the entire follicle, then a disease called sycosis occurs. Sycosis is most often found on the extensor areas of the limbs, in the area of abundant hair growth.

The most common causative agent of folliculitis is staphylococcus, which can normally be present on the surface of human skin. Staphylococci surround us everywhere: in the air, in the ground, in dust particles. However, only 10% of the population has staphylococcus with increased pathogenicity.

Staphylococci can be different. For example, the saprophytic microbe is completely safe and does not cause disease. The epidermal microbe is considered conditionally pathogenic. And Staphylococcus aureus is the most dangerous and always leads to the development of disease.

Staphylococcus aureus produces an enzyme that causes plasma coagulation. If such a microbe gets into the skin layers, then limited inflammation processes begin immediately: an abscess is formed.

In addition to staphylococcus, the disease can develop under the influence of pseudomonads, herpesvirus, fungi, and gram-negative microorganisms.

Is folliculitis contagious or not?

Since this is an infectious disease, it is certainly contagious. However, simply getting the infection to another person is not enough. For the disease to develop, a combination of certain factors is necessary, which we discussed above.

How is folliculitis transmitted? The infection can be spread by sharing towels, linens, and direct contact with the skin of an infected person.

The connection between lymphogranulomatosis and folliculitis has not yet been proven.

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Symptoms folliculitis

The symptoms of the disease vary depending on the extent to which the hair follicle is affected. For example, the lesion may be deep or superficial.

The superficial process is relatively easy. A small abscess appears on a separate area of skin near the hair follicle – no more than five millimeters in diameter. The pain is not very pronounced or is absent altogether.

As the process progresses and then subsides, the pustule transforms into an ulcer, becomes covered with a dry crust, which then falls off, leaving behind a slight hyperpigmentation.

The deep process is accompanied by the appearance of large nodular formations, with a relatively large diameter. Such formations cause not only discomfort, but also pain: a hair can be seen in the center of the nodule. After a certain period of time, the node opens, pus comes out, and a yellowish crust forms on the surface.

The number of inflammatory elements can vary from one or two to hundreds. If there are many inflamed follicles, systemic reactions can also be observed: nearby lymph nodes increase in size, and skin itching appears.

The first signs of the disease are swelling and redness around the hair follicle. Then a conical nodule with visible pus and a hair coming out in the center is formed.

The duration of the inflammatory reaction in one bulb is no more than one week. But, since folliculitis often manifests itself in multiple elements, the disease becomes permanent: some nodules open up, while others are just beginning to develop, etc.

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Folliculitis in men

The course of the disease in men has its own characteristics. For example, if the inflammation is caused by staphylococcus, then most often in men it manifests itself in the area of stubble growth: on the chin, near the mouth. In many men, the disease is complicated by the appearance of sycosis.

In men, gonorrheal infection causes inflammation of the foreskin (in women, this is the skin in the perineal area).

Herpetic inflammation of the follicles also most often affects men: the formation of vesicular elements is observed in the area of the mouths of the hair follicles. The most common location is the chin and nasolabial triangle.

It is also characteristic that men are less likely to consult a doctor about this disease, especially in the early stages of its development. Therefore, many patients develop complications, or the process becomes recurrent (chronic). Abscesses, hidradenitis, and lymphadenitis may develop.

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Folliculitis in women

In women, the disease is often associated with depilation procedures: incorrectly selected tools, dull blades, improper hair removal techniques, skin characteristics (for example, hypersensitivity of the skin) often cause inflammation of the follicles. In women, folliculitis is often confused with ordinary ingrown hairs.

Hormonal imbalances, pregnancy and menopause can also cause the development of an inflammatory process, because immunity is significantly weakened at this time. The state of the endocrine system, metabolism, and nutritional characteristics are also of great importance. Thus, excessive consumption of sweets is a fairly common cause of such a problem.

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Folliculitis in pregnant women

Inflammation of follicles during pregnancy is often explained by weak immunity, which is not uncommon during this period. The protective function of the skin weakens, due to which the infection penetrates into the tissues without any problems: folliculitis develops.

Additional factors include an unhealthy lifestyle, poor hygiene, lack of adequate rest and sleep, the use of synthetic clothing, and increased sweating.

Self-medication during pregnancy is strictly contraindicated. Therapy should be prescribed only by a specialist, after conducting specialized diagnostic measures. In uncomplicated cases, it is often possible to do without taking antibacterial agents, which is very important during pregnancy.

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Folliculitis in newborns

The course of the disease in childhood has its own special characteristics. In particular, the inflammatory process can be dangerous in newborns and infants, as it is caused by an infection that, due to the imperfection of the immune system, can spread to other tissues.

How does folliculitis progress in children? At first, blisters with white, yellowish or bloody contents appear. Blisters always form in the area of the skin where the hair comes out.

If the disease is of fungal origin, flattened zones limited by a border are formed on the scalp. Light plaques are localized on them, which gradually accumulate.

If folliculitis is suspected in a child, it is necessary to take all measures to maintain skin hygiene. The skin should always be clean, and the nails should be trimmed. It is advisable to use special gloves for infants to prevent scratching of the affected area.

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Stages

Inflammation of the follicles can manifest itself in different ways, depending on the pathogen, location, and stage of the process.

Depending on the course of the disease, a distinction is made between acute and chronic (recurrent) forms of the disease.

• Acute folliculitis develops rapidly, in a relatively short time a multitude of inflamed elements appear. At the end of the acute stage, the elements dry out and become covered with crusts, which soon fall off.
• Chronic folliculitis is characterized by periodically recurring exacerbations of the disease – relapses.

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Forms

• Hoffman's undermining scalp / hair folliculitis appears in the hair growth zone in men of any age category. A characteristic feature of this type of disease is the appearance of not external blisters with purulent contents, but subcutaneous elements of a bluish or yellow tint, without a central location of hair. If you press such an element with your finger, then the leakage of liquid will become noticeable.
• Bacterial, staphylococcal is caused by bacterial agents and most often occurs in the area of growth of bristly hairs. Most patients with bacterial lesions are men. The bacterial inflammatory process can be either superficial or deep.
• Superficial is characterized by the appearance of pustules of small diameter (less than five millimeters). The elements have a spherical shape and a reddish tint, while pain may be absent. As a rule, the superficial process opens up in about three days, after which a brownish crust forms on the lesion.
• Deep is accompanied by the appearance of dense nodules of a bright red hue, no more than one centimeter in diameter. Around the fifth day, the nodule dries up, after which a dry yellowish crust remains.
• Eosinophilic, allergic is typical for patients with HIV infection.
• Decalvant, as well as eosinophilic, appears as a result of AIDS and HIV infection, and is considered a chronic pathology. This type of disease is typical for representatives of the male population: the scalp is most often affected.
• Purulent, Bockhart's impetigo, develops as a result of increased sweating - for example, with prolonged use of warming procedures and lotions. Characteristic symptoms are superficial nodules, 2-5 mm in diameter.
• Abscessing is a complicated type of the disease, in which separate foci of inflammation with their purulent lesions are formed. As a result, multiple abscesses are formed - inflammatory elements, the cavity of which is filled with a purulent substance. Inflammatory elements are strictly localized: they form peculiar voids in the tissues.
• Candidal, fungal is expressed in the appearance of relatively large pustules, from the center of which hair comes out. The disease often develops with prolonged wearing of tight bandages (especially if ointments are used under the bandage - for example, hormonal composition). Cases of defeat of bedridden patients are not uncommon, mainly with a long-term fever, or in the hot season.
• Pseudomonas develops under the influence of the microorganism Pseudomonas aeraginosa. In the overwhelming majority of cases, the cause of such pathology is the use of hot water procedures using water that is not sufficiently treated with chlorine, or against the background of antibiotic treatment with subsequent chapping of the skin.
• Gram-negative, as the name suggests, is caused by gram (-) microbes. Often the cause of this disease is improper treatment of acne - for example, antibiotic therapy without a specific therapeutic regimen, without indications or with illiterately selected drugs. Such pathology is characterized by exacerbation of acne rashes, possible abscess formation of the process.
• Seborrheic is a type of sycosis - a chronic pustular disease caused by staphylococci. Mostly representatives of the strong half of humanity suffer from it. The course of the disease is persistent and prolonged, difficult to cure.
• Keratosis (follicular keratosis) is formed as a result of a genetic failure of the keratinization processes of hair follicles. This disease is hereditary and manifests itself in childhood and adolescence.
• Herpetic folliculitis is caused by a virus. Nodules appear in the area of the mouth of the hair follicles. In the second stage, superficial crusts form. The disease is diagnosed in the male population. The most common localization is the chin and nasolabial triangle.
• Pityrosporal is caused by lipophilic yeast fungi that live on the skin and mucous membranes of even healthy people. The second name of the pathology is Malassezia folliculitis. As a rule, the upper half of the body is affected, on which typical papulopustular rashes are found. The disease is accompanied by itching.
• Tick-borne occurs after damage by Demodex mites. During the disease, nodules and blisters appear against the background of reddened skin. Bran-like peeling can be observed in a circle from the follicular openings. If the tick-borne lesion affects the face, then clinical manifestations occur as rosacea.
• Syphilitic is a secondary manifestation of syphilis. In this case, the inflamed elements are located in the hair growth zone on the head and face.

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Complications and consequences

In most patients, with timely medical intervention, the disease can be successfully cured without any threat of complications.

But in some situations, a different outcome is possible. For example, if a patient begins to self-medicate, or was initially prescribed an incompetent treatment, or the patient did not observe the rules of personal hygiene, then unpleasant consequences may arise:

• development of furuncles, hidradenitis, damage to the lymph nodes;
• abscess formation process;
• development of carbuncles;
• the appearance of scars and age spots.

In some cases, the disease can become chronic. This can be caused by a long absence of treatment or long-term incorrect treatment of the inflammatory process in the follicles.

Recurrent folliculitis may also be caused by other factors, such as a severe weakening of the immune system or the presence of another chronic infectious disease. When the disease becomes chronic, it is necessary to conduct a comprehensive diagnosis to determine possible foci of chronic inflammation and the reasons for the decrease in the body's immune response. The question of the treatment tactics for such patients is decided individually.

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Diagnostics folliculitis

According to the basic existing scheme, the following procedures and tests are prescribed for diagnostics:

• bacterioscopy, bacteriological examination;
• General blood and urine tests.

The doctor draws conclusions about the possible cause of the disease, examines the affected areas, clarifies the symptoms and sensations of the patient. The following questions will be asked:

• What preceded the onset of the disease?
• Was any treatment given for the disease?
• What kind of lifestyle does the patient lead, what does he eat, what conditions does he live and work in?

If the patient suffers from eosinophilic folliculitis, bacterial cultures will not be able to show the growth of the infection. However, a large number of eosinophils are found in the secretions. Blood analysis is also indicative (eosinophilia is detected). Histological examination reveals perifollicular and perivascular eosinophilic infiltrates.

Instrumental diagnostics may include skin biopsy, but this method is rarely used for this type of pathology.

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Differential diagnosis

Differential diagnosis is carried out with the following disease states:

• acne;
• chemical attack;
• drug-induced toxicoderma (occurs after treatment with lithium or bromine preparations, corticosteroids);
• Kyrle's disease (essential follicular keratosis);
• diffuse neurodermatitis;
• ingrown hairs;
• acute deficiency of vitamins C or A;
• red pityriasis hairball (Deverzhi disease);
• prickly heat, diathesis;
• lupus erythematosus;
• transient acantholytic dermatosis.

Differentiation is also carried out depending on the location of the lesion:

• Folliculitis of the skin must be distinguished from furunculosis and pyoderma, from common and juvenile acne.
• Folliculitis on the face is distinguished from dermatophytosis, acne, facial dermatitis, follicular keratosis, ingrown hairs, and diathesis.
• Folliculitis of the nose is differentiated from acne, pimples, furuncles and facial dermatitis.
• Folliculitis of the neck must be differentiated from dermatophytosis of the beard, ingrown hairs, acne vulgaris, rosacea and keloid acne.
• Folliculitis on the legs must be distinguished from follicular keratosis and vitamin C deficiency.
• Folliculitis in the groin is differentiated from hidradenitis.
• Genital folliculitis is more often associated with gonorrheal or syphilitic lesions, as well as with the introduction of staphylococcal infection. Fungal inflammation is less common.
• Pubic folliculitis is usually caused by improper shaving and depilation – this problem is called pseudofolliculitis. However, this type of disease should be differentiated from staphylococcal and mycotic lesions.
• Folliculitis of the labia must be distinguished from hidradenitis.
• Folliculitis on the penis is in most cases associated with gonorrheal lesions, but other possible causes of the disease cannot be ruled out. Therefore, it is very important to carry out high-quality diagnostic measures.
• Folliculitis on the scrotum can occur due to friction of underwear, due to too tight clothing. Differential diagnostics in such a situation should be carried out with staphylococcal and fungal folliculitis.
• Folliculitis on the buttocks is most often caused by staphylococcus, but differentiation from fungal infection is necessary.
• Folliculitis on the back should be identified: it can be either pseudofolliculitis, staphylococcal folliculitis, or keloid acne.
• Folliculitis under the arm is usually caused by careless shaving, and can be caused by staph or pseudomonas infection. But furunculosis, abscesses or miliaria cannot be ruled out.

Folliculitis and furunculosis differ in that with furunculosis, the infectious lesion completely captures the sebaceous gland and adjacent tissues. Visually, this looks like a cone-shaped reddish nodule rising above the surface of the skin. As a rule, furuncles most often occur on areas of the skin that are characterized by increased oiliness.

What is the difference between pyoderma and folliculitis? They are essentially the same thing. That is, folliculitis is a type of pyoderma, and appears along with other pustular skin diseases. Pyoderma is usually differentiated from vasculitis, tuberculosis and syphilitic lesions, leishmaniasis, trichophytosis.

Treatment folliculitis

For folliculitis treatment to be effective, a comprehensive approach must be used. Often, it is not possible to successfully carry out therapy at home, so the choice may fall in favor of a hospital.

Prevention

In order to prevent the appearance or recurrence of the inflammatory process in the follicles, doctors advise paying special attention to walks, quality sleep and nutrition, and observing hygiene rules. If microdamages appear on the skin, it is necessary to treat such areas with a disinfectant.

If pustules appear on the skin, you should not try to deal with the problem yourself - it is better to consult a doctor in a timely manner.

To prevent the development of the disease, you need to follow these simple rules:

• You cannot use other people’s towels, hygiene products, washcloths, or underwear;
• If possible, any skin trauma, even minor ones, should be avoided;
• in hot weather you need to wash yourself more often, preferably with cool water;
• Men and women are advised to select shaving products individually, depending on the sensitivity of the skin;
• If you are prone to allergies, you need to be very careful when choosing cosmetics and skin care products, and even pay attention to such nuances as the quality of chlorination of the water in the pool, or the pH of the water used for washing.

If inflammation of the follicles occurs frequently, doctors advise reviewing your diet (limiting the amount of carbohydrates and fats), and also avoiding visiting baths, swimming pools, and saunas.

Staphylococcus vaccine for Malassezia folliculitis

Patients with chronic, recurrent folliculitis, in addition to antifungal, antibacterial and chemotherapeutic agents, may be prescribed immunotherapy. This treatment involves the introduction of antiphagin, staphylococcal anatoxin, antistaphylococcal immunoglobulin, staphylococcal vaccine. Vitamin therapy, autohemotherapy, pyrogenal, etc. are also prescribed.

In Malassezia folliculitis, the introduction of staphylococcal vaccine is rarely practiced - local and systemic treatment with antifungal agents is mainly used. Antifagin is not the drug of choice for Malassezia folliculitis due to the fact that this drug is used for diseases of staphylococcal origin. Such a vaccine causes the formation of specific antibacterial (antistaphylococcal) immunity.

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Forecast

The disease is considered to have a favorable prognosis. If the follicles are deeply affected, scars or pigment spots may appear at the end of the process.

Complications occur relatively rarely, but this depends on the correct treatment and its timeliness.

Limited superficial folliculitis can be cured within a week.

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