EpistemisFolliculitis
Specialty: Skin.
Why it occurs
- Superficial bacterial infection due to *Staphylococcus aureus* (most common cause of erythematous-pustular folliculitis)
- Infection by *Pseudomonas aeruginosa* secondary to exposure to contaminated warm water ("folliculitis from swimming pools or jacuzzis")
- Fungal colonization by yeasts of the genus *Malassezia* (folliculitis due to pityrosporum, common on the trunk of young adults)
- Constant friction from tight clothing and occlusion of the skin from oily cosmetics or massage oils
- Chronic use of topical corticosteroids or systemic antibiotics for acne.
Initial workup
Eminently visual diagnosis of the pustule centered by a hair. In recurrent, refractory or in-hospital cases, microbiological culture of the purulent content of the pustule for identification of the pathogen and determination of antibiotic resistance (especially MRSA).
red flags
Appearance of multiple deep and confluent very painful inflammatory nodules that evolve into fluctuating abscesses (anthrax or staphylococcal anthrax), rapidly progressive surrounding erythema with heat and pain, high fever, local lymphangitis or involvement in diabetic patients at risk of bacteremia.
Standard management
- Mupirocin 2% cream — topical antibiotic of first choice applied to the affected follicular area 3 times a day for 5 to 7 days
- Topical 1% clindamycin in solution — useful in localized bacterial folliculitis of the trunk or face
- Cloxacillin — oral antibiotic indicated in extensive cases of staphylococcal folliculitis, dose of 500 mg every 6 hours orally for 7 to 10 days
- Fluconazole (oral antifungal indicated if Malassezia etiology is confirmed, dose of 100 to 200 mg daily for 1 to 2 weeks).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Skin
- Listed causes
- 5
- Treatment options
- 4