Folliculitis

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Folliculitis is an infection of the hair follicles commonly due to Staphylococcus aureus, and Gram- negative bacteria such as Pseudomonas and Candida albicans. 

Clinical presentation 

Clinical features depend on risk factors, which may result into Pseudo-folliculitis, Carbuncles aggregation and Furuncle (boil). The following are some of the clinical features: 

• Scattered or extensive follicular pustules 
• Macular or papulo-erythematous lesions, mainly located on thighs, buttocks, back and bearded area
• Papules and pustules
• Post-inflammatory hyperpigmentation
• Necrosis and suppuration with discharge of necrotic core
• Permanent scars or scarring alopecia
• Firm, broad swollen, painful, fluctuant deep nodules
• Multiple drainage tracts
• Fever and general body malaise

Non-pharmacological Treatment 

• Suspected irritants should be avoided
• In  Pseudo-folliculitis  (infection  of  the  follicular  opening)  of  the  bearded  area,  shaving should be stopped for several weeks until improvement occurs. Hair should be left to grow to at least 1 mm long
• Shaving with electric razors is preferred over manual razors for beard folliculitis. Cleaning with water and soap

Pharmacological Treatment

A: potassium permanganate soaks, 1:40000 (0.025%) solution 12hourly for 3–4days. Each session for 15 to 20minutes 

Apply:  

A: gentian violet paint (topical) 0.5% 12hourly for 5days 

OR 

C: mupirocin (topical) 2% 12hourly for 7-14days 

OR  

C: fusidic acid (topical) 2% 12hourly for 7-14days 

Note: If  severe,  or  systemic  symptoms  are  present  (e.g.  pyrexia)  add  an  oral  antibiotic  as  above  in  impetigo. 

Fungal folliculitis 

A: clotrimazole cream (topical) 12hourly for 4weeks 

OR  

C: miconazole cream (topical) 12hourly for 4weeks