What is the Folliculitis
What in medical terms is called "folliculitis" consists of inflammation and acute infection of the upper part of the hair follicle.
Brief anatomical reference to the Hair Follicle
Human skin is covered with over 5 million hair follicles: these are tiny epidermal structures sunk into the dermis, each of which is made up of a hair and its sheaths.
While the portion that emerges from the skin is called a rod (or hair shaft), the portion that sinks into the skin is known as the root .
Attached to each hair follicle is a sebaceous gland, which pours its contents into it. At the rear, instead, there is the erector muscle of the hair that is activated in response to thermal stimuli (cold) or strong emotions (fear), erecting the hair shaft and giving rise to the so-called goose bumps.
The follicle is also constituted by the bulb, which in turn receives the dermal papilla, an anatomical element essential for vascularizing the follicle.
We talk about folliculitis when one or more of these anatomical structures suffer an infectious insult.
Causes
The causes behind the folliculitis are many and not always easily identifiable. In general, infections are the main trigger; more specifically, infectious folliculitis is mainly caused by:
- Bacteria (eg Staphylococcus aureus and Pseudomonas aeruginosa )
- Mushrooms (eg Candida albicans, fungi of the genus Malassezia and Trichophyton rubrum )
- Virus (eg Herpes simplex )
However, the list of potential causes seems to be quite long.
Below, some possible risk elements (or, in some cases, triggers) for folliculitis will be listed.
- Excessive sweating;
- Occlusion of hair follicles induced by the frequent use of adherent clothes;
- Shaving, especially if done against hair;
- Presence of skin lesions;
- Dermatosis or other skin diseases;
- Immunodepression (in this case, it generates what is called "eosinophilic folliculitis", particularly widespread in AIDS patients, but which can occasionally occur even in healthy individuals);
- Diabetes mellitus;
- Obesity;
- Bites or insect bites.
In many patients, unfortunately, the main cause of the follicle infection - especially in its relapsing form - still remains an unresolved question (idiopathic nature of the disorder).
In some cases, however, the causes triggering the folliculitis may not be of bacterial, fungal or viral origin. Therefore, in this type of situation, one speaks of " non-infectious folliculitis ". Examples of non-infectious folliculitis are:
- Folliculitis "from oil" or "from oils": it is an inflammation of the hair follicles caused by exposure to mineral oils derived from oil. It typically occurs at the level of the forearms and affects mostly refinery workers or road maintenance workers.
- Shaving pseudofollicolite: it is a type of folliculitis that occurs when the hair penetrates the skin before it even comes out of the hair follicle. In this way foreign body irritation and inflammation are created, resulting in the formation of "pimples" typical of folliculitis which, however, are not triggered by a bacterial infection.
You know you used to ...
It has been observed that patients suffering from iron deficiency anemia are statistically more exposed to the risk of chronic folliculitis.
Incidence
Folliculitis is a disorder that can occur at all ages and in individuals of any ethnicity, both male and female.
As mentioned, the folliculitis can affect any cutaneous area that hosts hairs: the disorder can therefore manifest itself in any point of the skin surface, except for the palms of the hands and the soles of the feet (the only areas of the really glabrous skin, or without hair).
However, since the skin of the male face is continually subject to shaving, in men the folliculitis tends to occur mainly in the area of the beard. In women, however, the same disorder occurs most frequently in the skin of arms, legs and buttocks.
Signs and symptoms
To learn more: Folliculitis symptoms
Superficial folliculitis - the most common form - begins with red boils and / or small pustules filled with pus near the follicles. The size of the pustules depends on the depth of the infection and the extent of the damage.
Sometimes, on the skin affected by folliculitis, it is also possible to observe small purulent vesicles with the classic yellow cap which, when burst, leave small crusts.
Summarizing briefly, the folliculitis - which can occur in any area of the skin covered with hair - manifests itself with signs and symptoms such as:
- Red boils;
- Small pustules stuffed with pus;
- Small purulent vesicles which, once burst, leave crusts;
- Itch;
- Skin redness;
- Small scars;
- Ache.
Treatment
Treatment for this disorder clearly depends on the type of folliculitis and the extent of the lesions. Before proceeding with the treatment, it is therefore necessary to establish the causal agent responsible. Therefore, for healing purposes, the differential diagnosis is indispensable.
Superficial folliculitis
Superficial folliculitis requires careful body hygiene and the exclusive use of neutral and extremely delicate soaps.
Infectious folliculitis
As previously mentioned, infectious folliculitis can be triggered by different types of microorganisms, such as bacteria, viruses or fungi. The therapy for each of these infections, therefore, varies according to the causative pathogen.
The main infectious folliculitis and the therapies needed to treat them will be briefly described below.
Refractory or deep lesions
Refractory or deep lesions, especially in cases of suspected ongoing infection, require a diagnostic test: in similar circumstances, topical / oral administration of antibiotics is the most appropriate treatment.
Did you know that ...
Staphylococcus aureus is rather resistant to the action of penicillin; for this reason, the infectious folliculitis sustained by this pathogen is generally treated with other antibiotics such as dicloxacillin, rifampicin or a cephalosporin.
Methicillin-resistant microorganisms can instead be eradicated with clindamycin, minocycline or the combination of trimethoprim and sulfamethoxazole.
Folliculitis supported by Pseudomonas
Folliculitis supported by Pseudomonas are generally self-limiting and do not always require pharmacological intervention. However, when the patient has a weakened immune system, oral treatment with ciprofloxacin is recommended.
Folliculitis from Gram-negative bacteria
It is a particular type of folliculitis which usually occurs in the case of antibiotic therapies against acne that last over time. The treatment of this type of folliculitis involves the use of antibiotics effective against topical or oral Gram-negative microorganisms, according to the doctor's opinion.
Of course, the antibiotics to be used will have to be different from those used previously for the treatment of acne, whose long-term use has given rise to folliculitis.
Herpetic Folliculitis
Herpetic folliculitis (therefore, of viral origin) is generally removed with antivirals such as valaciclovir, famciclovir, or aciclovir.
Fungal Folliculitis
Infections with follicles supported by mycetes are instead eradicated with antifungals such as fluconazole and econazole: the peculiarity of mycotic folliculitis is the tendency to recur. For this reason, affected patients should continue topical (local) therapy with antifungal drugs even after the symptoms have disappeared.
Non-infectious folliculitis
Non-infectious variants of folliculitis do not require the use of antibiotics, antifungals or antivirals. Depending on the cause, patients suffering from these infections are treated with topical or systemic administration of cortisone-based medicines.
Immunocompromised patients suffering from non-infectious folliculitis may benefit from the administration of immunostimulant drugs possibly associated with a cortisone cure.
Phototherapy is an alternative, sometimes effective intervention for the treatment of non-infectious folliculitis.
Read also: Folliculitis Remedies »
