Folliculitis: The Term for a Single Inflamed Follicle
Folliculitis is the medical term for a single inflamed hair follicle, characterized by a superficial inflammation of the hair follicle that presents as a small pustule or papule through which a hair emerges. 1
Characteristics and Diagnosis
Folliculitis is distinguished from other follicular infections by its superficial nature:
- Involves inflammation in the superficial aspect of the hair follicle 2
- Presents as small (approximately 1mm) vesicles, pustules, or papulopustules 2
- Inflammation is more superficial than furuncles, with pus present in the epidermis 1
- Each lesion consists of an inflammatory papule or pustule with a hair emerging through it
Differentiation from Other Follicular Infections
It's important to distinguish folliculitis from other follicular infections:
- Furuncles (boils): These are deeper infections of the hair follicle where suppuration extends through the dermis into subcutaneous tissue, forming a small abscess 1
- Carbuncles: When infection extends to involve several adjacent follicles, producing a coalescent inflammatory mass with pus draining from multiple follicular orifices 1
- Kerion: A painful, boggy, inflammatory mass with associated alopecia, often misdiagnosed as bacterial abscess 1
Etiology
Folliculitis can have various causes:
- Bacterial: Most commonly caused by Staphylococcus aureus 1
- Fungal: Including Malassezia folliculitis, which is often misdiagnosed as bacterial folliculitis 3
- Viral: Herpes simplex, herpes zoster, and molluscum contagiosum can cause viral folliculitis 4
- Non-infectious: Can be caused by irritation, occlusion, or medication reactions 5
Management
Treatment depends on the extent and cause of folliculitis:
Topical therapy: For limited disease, including antiseptics (chlorhexidine wash, benzoyl peroxide) or antimicrobials (clindamycin, erythromycin) applied twice daily for at least 14 days 5
Supportive care: Includes gentle cleansing with pH-neutral soaps, warm compresses to promote drainage, and avoiding alcohol-based products 5
Systemic antibiotics: Reserved for extensive surrounding cellulitis, systemic symptoms, multiple lesions, or immunocompromised patients 5
Specific pathogen-directed therapy:
Prevention
Preventive measures include:
- Proper hygiene with pH-neutral, non-irritating soaps
- Wearing loose-fitting, cotton clothing
- Avoiding sharing personal items like razors or towels
- Regular changing of clothing 5
When to Consider Referral
Consider referral to a dermatologist for:
- Extensive or severe disease
- Recurrent episodes
- Development of scarring
- Immunocompromised patients 5
Folliculitis should be reassessed after 2 weeks of treatment, with escalation to the next level of treatment if no improvement is seen 5.