Folliculitis of the head, face, legs and groin

Literally the name "folliculitis" means inflammation of the follicle - that is, the hair bulb. This disease belongs to the category of purulent pathologies: it proceeds sharply and is manifested by the appearance of reddish pustules, gradually turning into abscesses with yellowish-greenish contents inside. Foci of folliculitis, as a rule, hurt and cause a lot of discomfort to the patient.

Folliculitis can have a different etiology, according to which the doctor determines the treatment of the disease.

[1], [2], [3], [4], [5]

Epidemiology

Most patients with inflammation of the follicles are residents of countries with a hot and humid climate. In addition, the disease is diagnosed, mainly, in case of non-observance of sanitary conditions.

The disease can have a strictly professional origin: for example, it affects people who are in general contact with chemicals, detergents, oil products, lubricants.

Accurate statistical data on morbidity is not provided, as many patients do not treat a similar problem with doctors and practice self-treatment. Unfortunately, dermatologists have to start treatment already when the disease is complicated: there is lymphadenitis, abscess, etc.

[6], [7], [8], [9]

Causes of the folliculitis

Folliculitis can develop for many reasons. Often such a form of purulent inflammation appears when the hygiene norms and rules are ignored, and various microdamages and maceration of the skin create a favorable background for infection to enter the tissues.

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

Inflammation of the follicles is not uncommon in case of impaired liver function, malnutrition, diabetes mellitus.

If the patient suffers from pruritus of the skin, the risk of getting the infection inside the follicle increases. Through scratches and scratching bacteria get into the depths of tissues. The situation is aggravated if the patient has increased sweating.

Special oppression of local immune defense occurs with prolonged or chaotic use of hormonal ointments and creams.

Among the professional causes of the disease can be called a frequent hit on the skin of technical fluids, fuel oil, chemical reagents.

Malassassia is the cause of folliculitis

Malassassia is a yeast-like fungus that can be isolated on the skin of a healthy person, as it is considered an ordinary component of the flora. However, this fungus is often the cause of certain diseases, which are called malasshesiosis. These include seborrheic dermatitis and psoriasis, facial and cervical atopic dermatitis, pityriasis 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 the inflammatory process at the rate of fungal colonies.

The inflammatory process occurs:

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

Malassassia-folliculitis is attributed to the infectious group, along with otaroid dyspepsia, neonatal pustules and otitis media.

[10], [11], [12]

Risk factors

Folliculitis is considered an infectious pathology, which can occur not only under the influence of microbes, but also viruses or fungi. However, only an infectious invasion for the development of the disease is not enough: the main role is played by the creation of favorable conditions for the development of the inflammatory process. Therefore, important factors belong to certain risk factors.

Such factors can be external and internal.

External factors include:

• microdamaging of the skin;
• contaminated, greasy or sweaty skin;
• excessively tight or dense clothing, mainly of synthetic composition, as well as long-term removable bandages, plasters, bandages, etc .;
• hot climate, high humidity;
• supercooling.

Internal factors include:

• decreased hemoglobin level;
• Endocrine disorders, obesity, diabetes mellitus;
• malnutrition (excess salt, fats and / or carbohydrates in food, preferential food in dry conditions);
• liver disease;
• local treatment with hormonal ointments, as well as taking hormonal drugs or immunosuppressants orally.

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

• Folliculitis after shugaring / folliculitis after depilation is one of the complications of the procedure if it is performed improperly, or with excessively sensitive skin. In most cases, this development of folliculitis is a consequence of hair ingrowth: after the hair is removed, the skin becomes denser and the newly grown hair is on the contrary thinner. As a result, the new hair can not 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 a site invariably leads to the onset of folliculitis and pustules.
• Folliculitis after shaving is formed, both after ingrown hairs inside the skin, and after using a razor with a blunt blade. Often the cause is also improper shaving, when the hair shaves against its growth. This causes microdamaging of the skin at the points where the hair extends outward, which becomes a favorable environment for infection.
• Folliculitis after Elocom ointment, or other hormonal preparations, appears in case the agent 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, depriving, atopic dermatitis. However, such ointments are dispensed without a prescription, so often there are cases of self-administration of the drug without consulting a doctor. It is in these patients most often and develops a medical folliculitis. Tip: any treatment must be coordinated with the doctor.

[13], [14], [15], [16]

Pathogenesis

Folliculitis is a dermatological pathology, which is considered to be a group of superficial pyoderma (pustular diseases).

With the folliculitis, the superficial areas of the hair follicles become inflamed, while the inflammation is infectious.

How does the process develop? First a papula is formed in the area of the follicular estuary. Further the papule is transformed into a pustule, in the center of which the hair is located. After this, a crust appears on the surface of the follicle.

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

As the causative agent of folliculitis is most often staphylococcus, which can normally be present on the surface of the skin of a person. Staphylococci surround us everywhere: in the air, in the ground, in dust particles. However, only 10% of the population have staphylococcosis with increased pathogenicity.

Staphylococci can be different. For example, a saprophyte microbe is completely safe and does not lead to a disease. The epidermal microbe is considered opportunistic. A golden Staphylococcus is the most dangerous and always leads to the development of the disease.

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

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

Folliculitis is contagious or not?

Since this disease is an infectious genesis - certainly, it is contagious. However, simply getting the infection to another person is not enough. For the development of the disease requires a combination of certain factors, of which we spoke above.

How is the folliculitis transmitted? Infection can spread with the use of shared towels, general linen, and also with direct contact with the patient's skin.

The connection of lymphogranulomatosis and folliculitis has not been proved at the moment.

[17], [18], [19], [20], [21],

Symptoms of the folliculitis

Symptoms of the disease manifest themselves in different ways, depending on the extent to which the hair follicle is affected. For example, the lesion can be deep or shallow.

The surface process proceeds relatively easily. On a separate area of the skin, a small ulcer appears on the hair bulb - no more than five millimeters in diameter. The pain is not very pronounced, or absent at all.

With the growth and further stagnation of the process, the abscess transforms into a sore, is covered with a dry crust, which then disappears, leaving behind a small hyperpigmentation.

A deep process is accompanied by the appearance of large knobby formations, with a relatively large diameter. Such formations deliver not only discomfort, but also pain: you can see hair in the center of the nodule. After a certain period of time, the node is opened, the 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 inflamed follicles are many, then there may be systemic reactions: enlarged closely located lymph nodes, skin pruritus appears.

The first signs of the disease are the appearance of puffiness and redness around the hair follicle. Further, a conical nodule with visible pus and a hair outlet in the center is formed.

The duration of the inflammatory reaction in one bulb is not more than one week. But, since folliculitis often manifests itself in multiple elements, the disease acquires a permanent character: some nodules are opened, others only begin to develop, and so on.

[22]

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 appears in the zone of growth of the bristles: on the chin, near the mouth. In many men, the disease is complicated by the appearance of sycosis.

In gonorrheal lesions, men become inflamed with the foreskin (in women it is the skin in the perineal region).

Herpetic inflammation of the follicles, too, most often affects men: the formation of bubble elements in the mouth of hair follicles. The most common location is the zone of the chin and nasolabial triangle.

It is also characteristic that men rarely consult a doctor about this disease, especially at the initial stages of its development. Therefore, many patients develop complications, or the process becomes relapsing (chronic). Possible the development of abscesses, hydradenitis, lymphadenitis.

[23], [24]

Folliculitis in women

In women, the appearance of the disease is often associated with depilation procedures: incorrectly selected tools, blunt blades, illiterate hair removal techniques, skin features (for example, skin hypersensitivity) often cause inflammation of the follicles. In women, folliculitis is often confused with the usual ingrowth of hair.

Differences in the hormonal balance, pregnancy and menopause can also cause inflammation, because immunity at this time is significantly weakened. Of great importance is the state of the endocrine system, metabolism, and also the peculiarities of nutrition. So, excessive consumption of sweets is a fairly common reason for such a problem.

[25], [26], [27], [28]

Folliculitis in pregnant women

Inflammation of the follicles during pregnancy is often due to the weakness of immunity, which is not uncommon in this period. The protective function of the skin is weakened, so that the infection penetrates into the tissues without any problems: the folliculitis develops.

Additional factors are the wrong way of life, lack of hygiene, lack of proper rest and sleep, the use of synthetic clothing, increased sweating.

Self-treatment during pregnancy is contraindicated categorically. Only specialist should prescribe therapy, after carrying out specialized diagnostic measures. In uncomplicated cases it is often possible to do without taking antibacterial drugs, which is very important during pregnancy.

[29], [30], [31], [32], [33], [34]

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 imperfections in the immune system, can spread to other tissues.

How does folliculitis occur in children? In the beginning, bubbles appear with white, yellowish or bloody contents. Always bubbles form in the area of the skin where the hair extends.

If the disease has a fungal origin, then on the scalp formed flattened zones, bordered by the fringe. They are localized light plaques, which gradually accumulate.

If the child is suspected of folliculitis, then it is necessary to take all measures to maintain the hygiene of the skin. The skin should always be clean, and the nails should be cut. In babies it is advisable to use special gloves, to prevent combing the affected area.

[35], [36], [37]

Stages

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

The acute and chronic (recurrent) form of the disease is distinguished along the course.

• Acute folliculitis develops rapidly, in a relatively short time there are many inflamed elements. At the end of the acute stage, the elements dry up and become covered with crusts, which soon fall off.
• Chronic folliculitis is characterized by recurrent exacerbations of the disease - relapses.

[38], [39], [40], [41]

Forms

• Undermining the Hofmann scalp / hair folliculitis manifests itself in the hair growth zone in men of any age category. A characteristic difference of this type of disease is the appearance of not external blisters with purulent contents, but subcutaneous elements of bluish or yellow hue, without the central arrangement of the hair. If you squeeze such an element with your finger, the flow of liquid will become noticeable.
• Bacterial, staphylococcal is caused by bacterial agents and more often occurs in the growth zone of bristly hairs. Most patients with a bacterial lesion 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 are globular and have a reddish hue, and pain may be absent. As a rule, the surface process is opened in about three days, after which a brownish crust forms on the hearth.
• Deep is accompanied by the appearance of dense nodules of a bright red hue, with a diameter of not more than one centimeter. Approximately on the fifth day the nodule dries, after which a dry yellowish crust remains.
• Eosinophilic, allergic is characteristic for patients with HIV infection.
• Decalvering, as well as eosinophilic, appears as a result of AIDS and HIV infection, and is considered a chronic pathology. This kind of disease is typical for representatives of the male population: the skin on the head is often affected.
• Purulent, Bokhart impetigo, develops as a result of intense sweating - for example, with prolonged use of warming procedures and lotions. Typical symptoms are nodules of superficial location, with a diameter of 2-5 mm.
• Abscessing is a complicated form of the disease, at which individual foci of inflammation form with their purulent lesion. 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.
• Candidiasis, fungal is expressed in the appearance of relatively large pustules, in the center of which comes out hair. The disease often develops with prolonged wearing of dense dressings (especially if ointments are used for the bandage - for example, hormonal composition). It is not uncommon for cases of the defeat of recumbent patients, mainly with prolonged fever, or during the hot season.
• Pseudomonas is developed under the influence of the microorganism Pseudomonas aeraginosa. In most cases, the cause of this pathology is the use of hot water procedures using insufficiently chlorinated water, or against the background of antibiotic treatment with further airing of the skin.
• Gram-negative, as is clear from the name, is caused by gram (-) microbes. Often the cause of this disease is improper treatment of acne - for example, antibiotic therapy without a specific therapeutic scheme, without evidence or illiterate drugs. For such a pathology is characterized by exacerbation of acne eruptions, possible abscessing of the process.
• Seborrheic is a kind of sycosis - a chronic pustular disease that is caused by staphylococci. Sufferers are mainly representatives of the strong half of humanity. The course of the disease is persistent and prolonged, it is difficult to cure.
• Keratosis (follicular keratosis) is formed as a result of genetic failure of the processes of keratinization of hair follicles. This disease is hereditary and manifests itself in childhood and adolescence.
• Herpetic folliculitis is caused by a virus. There is an appearance of nodules in the region of the mouth of the hair follicles. In the second stage, surface crusts are formed. The disease is diagnosed in the male population. The most frequent localization is the chin and nasolabial triangle.
• Pityrosporal is caused by lipophilic yeast fungi, which live on the skin and mucous membranes of even healthy people. The second name of the pathology is the malassecting folliculitis. As a rule, the upper half of the body is affected, on which typical papulopustular eruptions are found. The disease is accompanied by itching.
• Kleshchevoy occurs after the defeat of mites Demodex. During the illness, nodules and vesicles appear on the background of reddened skin. In a circle from the follicular estuaries, it is possible to observe the off-cut peeling. If the tick affected affects the face, then the clinical manifestations appear as a pink acne.
• 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.

[42], [43], [44], [45], [46]

Complications and consequences

In most patients with timely medical intervention, the disease lends itself to a successful cure without any threat of complications.

But in some situations, a different outcome is possible. For example, if a patient begins to engage in self-treatment, or he was initially prescribed illiterate treatment, or the patient did not follow the rules of personal hygiene, then unpleasant consequences can arise:

• development of furuncles, hydradenitis, defeat of lymph nodes;
• abscessing of the process;
• development of carbuncles;
• appearance of scars, pigment spots.

In some cases, the disease can become chronic. This may lead to a long absence of treatment, or a prolonged wrong treatment of the inflammatory process in the follicles.

Recurrent folliculitis can be caused by other factors - for example, a strong weakening of immunity or the presence of another chronic infectious disease. When the disease is transferred to a chronic form, it is necessary to conduct a comprehensive diagnosis to determine possible foci of chronic inflammation and the causes of a decrease in the immunological response of the organism. The question of the tactics of treating such patients is solved individually.

[47], [48], [49], [50], [51], [52]

Diagnostics of the folliculitis

According to the basic existing scheme, for diagnostics such procedures and analyzes are appointed:

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

The doctor draws conclusions about the possible cause of the disease, examines the site of the lesion, clarifies the symptoms and feelings of the patient. The following questions will be asked:

• What preceded the appearance of the disease?
• Was there any treatment for the disease?
• What way of life does the patient lead, how does he feed, in what conditions does he live and work?

If the patient suffers from eosinophilic folliculitis, the bapsides will not be able to show an increase in infection. In this case, a large number of eosinophils are found in the secretions. Indicative and a blood test (found eosinophilia). In histological examination perifollicular and perivascular eosinophilic infiltrates are determined.

Instrumental diagnosis may include a biopsy of the skin, but this method is rarely used for this pathology.

[53], [54]

Differential diagnosis

Differential diagnosis is performed with the following morbid conditions:

• acne disease;
• defeat by chemical agents;
• drug toxicosis (occurs after treatment with lithium or bromine preparations, corticosteroid drugs);
• Kirl's disease (essential follicular keratosis);
• diffuse neurodermatitis;
• ingrowth of hair;
• acute deficiency of vitamins C or A;
• red pityriasis hair follicles (b-nd Devergie);
• jersey, diathesis;
• lupus erythematosus;
• transient acantholytic dermatosis.

Differentiate also according to the place of the lesion:

• Follicular skin should be distinguished from furunculosis and pyoderma, from ordinary and youthful acne.
• Folliculitis on the face is distinguished from dermatophytosis, acne, facial dermatitis, follicular keratosis, ingrown hair, diathesis.
• Folliculitis of the nose is differentiated from acne, acne eruptions, boils and facial dermatitis.
• Folliculitis of the neck needs to be differentiated from the dermatophytes of the beard, from ingrown hairs, common acne, pink and keloid acne.
• Folliculitis on the legs should be distinguished from follicular keratosis and avitaminosis C.
• Folliculitis in the groin is differentiated with hydradenitis.
• Sexual folliculitis is more often associated with gonorrheal or syphilitic lesions, as well as with the introduction of staphylococcal infection. Fungal inflammation is less common.
• Folliculitis on the pubic part is usually provoked by abnormal shaving and depilation - a problem called pseudofolliculitis. However, this kind of disease must be differentiated from staphylococcal and mycotic lesions.
• Folliculitis of the labia must be distinguished from hydradenitis.
• Folliculitis on the penis in most cases is associated with gonorrhea lesions, but other probable causes of the disease can not be ruled out. Therefore, it is very important to carry out qualitative diagnostic measures.
• Folliculitis on the scrotum can occur due to friction of the laundry, because of too tight clothing. Differential diagnosis in this situation should be carried out with staphylococcus and fungal folliculitis.
• Folliculitis on the buttocks is more often caused by staphylococcus, but differentiation with fungal infection is necessary.
• Folliculitis on the back should be identified: it can be, like pseudofolliculitis, and staphylococcal folliculitis, or keloid acne.
• Folliculitis under the arm usually occurs due to inaccurate shaving, and can be caused by a staphylococcal or pseudomonas infection. But you can not exclude the presence of furunculosis, abscesses or sweating.

Folliculitis and furunculosis differ in that, with furunculosis, infection infects completely the entire sebaceous gland and nearby tissues. Visually, it looks like a cone-shaped reddish knot that rises above the surface of the skin. As a rule, boils often appear on skin areas, which are characterized by increased greasiness.

What is the difference between pyoderma and folliculitis? It's essentially the same thing. That is, folliculitis is a kind of pyoderma, and acts along with other pustular skin diseases. Pyoderma usually differentiate with vasculitis, tuberculosis and syphilitic lesions, leishmaniasis, trichophytosis.

Treatment of the folliculitis

To treat folliculitis was effective, you need to apply a comprehensive approach. Often, therapy successfully at home is not possible, so the choice may fall in favor of the hospital.

Prevention

In order to prevent the appearance or re-development of the inflammatory process in the follicles, doctors advise to pay special attention to walks, quality sleep and nutrition, hygiene rules. When microdamages occur on the skin, it is necessary to treat such areas with a disinfectant.

When the pustules on the skin do not try to deal with the problem on your own - it's better to consult a doctor on time.

To prevent the development of the disease must adhere to such simple rules:

• Do not use other people's towels, hygiene products, scouring pads, linens;
• If possible, avoid any skin trauma, even minor ones;
• in the hot season it is necessary to wash more often, preferably with cool water;
• men and women are advised to select shaving aids individually, depending on the sensitivity of the skin;
• with a tendency to allergies, you need to carefully choose cosmetics and skin care products, and even pay attention to such nuances as the quality of chlorination in the pool, or the pH of the water used for washing.

If inflammation of the follicles occurs frequently, doctors advise to revise their diet (to limit the amount of carbohydrates and fats), as well as avoid visiting baths, swimming pools, saunas.

Staphylococcin in malasseous folliculitis

Patients with a chronic, recurrent course of folliculitis, in addition to antifungal, antibacterial and chemotherapeutic agents, may be prescribed immunotherapy. Such treatment involves the administration of antifagin, staphylococcal anatoxin, antistaphylococcal immunoglobulin, staphylococcin. Also prescribed are vitamin therapy, autohemotherapy, pyrogenal, etc.

With malassesia folliculitis, the introduction of staphylococcin is rarely practiced - it is used primarily by local and systemic treatment with antifungal agents. Antifagin with malassassive folliculitis is not a drug of choice due to the fact that this remedy is used for diseases of staphylococcal origin. Such a vaccine causes the formation of a specific antibacterial (antistaphylococcal) immunity.

[55], [56], [57]

Forecast

It is believed that the disease has a favorable prognosis. If the follicles are deeply affected, scar or pigmented spots may appear at the end of the process.

Complications are relatively rare, but this depends on the correct treatment and on its timeliness.

Limited surface folliculitis can be cured within a week.

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