From the Guidelines
Folliculitis is a superficial skin infection involving the hair follicle, typically caused by Staphylococcus aureus, and can be treated with antibiotics or drainage alone.
Diagnosis and Treatment
- The diagnosis of folliculitis is based on clinical presentation, with symptoms including inflammation, pus, and crust formation around the hair follicle 1.
- Treatment options for folliculitis include antibiotics, such as penicillin, amoxicillin, or clindamycin, which are effective against streptococci and Staphylococcus aureus 1.
- For uncomplicated cases, a 5-day course of antimicrobial therapy may be sufficient, while more severe cases may require longer treatment durations or incision and drainage 1.
- In cases of recurrent furunculosis, eradication of staphylococcal carriage using antibacterial agents, such as mupirocin ointment or clindamycin, may be necessary to prevent future infections 1.
- It is essential to assess the necrotizing or non-necrotizing character of the infection, anatomical extension, and clinical conditions of the patient to classify and manage skin and soft tissue infections effectively 1.
Management
- Moist heat can promote drainage and is satisfactory for small furuncles, while larger furuncles and carbuncles require incision and drainage 1.
- Systemic antibiotics are usually unnecessary unless there is evidence of systemic infection, such as fever or extensive surrounding cellulitis 1.
- Control of outbreaks may require measures such as bathing with antibacterial soaps, thorough laundering of clothing and bedding, and attempted eradication of staphylococcal carriage among colonized individuals 1.
From the Research
Diagnosis of Folliculitis
- The diagnosis of folliculitis occasionally requires histologic confirmation and cannot be based solely on clinical appearance of scalp lesions 2
- Malassezia folliculitis manifests as a pruritic, follicular papulopustular eruption distributed on the upper trunk, and diagnosis can be confirmed by microscopic examination of a sample obtained by tape stripping or comedo extractor, or by biopsy 3
- Patient's history, comorbidities, and clinical presentation are usually indicative of folliculitis, but microscopic and histological examination is needed to confirm the diagnosis 3
Treatment of Folliculitis
- Oral isotretinoin has been shown to be an effective treatment for folliculitis decalvans, with a success rate of 90% in achieving stable remission 4
- Topical antibiotics, topical antiseptics, systemic antibiotics, phototherapy, and incision and drainage are all potential treatments for bacterial folliculitis and boils, but the evidence for their effectiveness is limited and often of low certainty 5
- For Malassezia folliculitis, therapy should include systemic or topical measures for the control of the inflammation, as well as the prevention of recurrences 3
- Prophylactic doxycycline and topical steroids, along with gentle washing techniques, may be effective in preventing and managing laser-induced folliculitis 6
Types of Folliculitis
- Infectious folliculitis, noninfectious folliculitis, and perifolliculitis are three groups of folliculitis, with different causes and characteristics 2
- Malassezia folliculitis is a type of folliculitis caused by the yeast Malassezia, and is commonly seen in young to middle-aged adults and immunosuppressed individuals 3
- Laser-induced folliculitis is a type of folliculitis that can occur after laser hair removal, and is thought to be similar to pseudofolliculitis barbae in its mechanism of onset 6