EpistemisInflammatory follicular papules
Specialty: Skin.
Why it occurs
- Obstruction and inflammation of the follicular infundibulum secondary to sebaceous hypersecretion and bacterial proliferation (*Cutibacterium acnes* in papulopustular acne vulgaris)
- Follicular superficial infection by *Staphylococcus aureus*
- Eosinophilic folliculitis (associated with advanced stages of HIV infection or idiopathic)
- Acneiform drug reaction (eruption induced by the systemic use of glucocorticoids, lithium or anticonvulsants)
- Local hypersensitivity reaction to hair after shaving or waxing (pseudofolliculitis).
Initial workup
Clinical examination of the anatomical distribution of the lesions. Gram stain and microbiological culture of the purulent contents if there is suspicion of bacterial resistance (MRSA). Tzanck cytological smear if it is necessary to differentiate from atypical follicular herpetic infections.
red flags
Presence of multiple confluent papules of firm consistency that are extremely painful and rapidly evolve into deep abscesses interconnected with fistulous tracts (acne conglobata or dissecting cellulitis), accompanied by generalized malaise and high fever.
Standard management
- 5% benzoyl peroxide gel — keratolytic and bactericidal topical antiseptic that prevents bacterial resistance; applied at night
- Topical clindamycin 1% combined with benzoyl peroxide — first choice treatment in mild to moderate inflammatory papules of acne
- Doxycycline — oral antibiotic indicated in cases of moderate to severe diffuse follicular inflammation, dose of 100 mg daily orally for a maximum of 12 weeks due to its anti-inflammatory effect
- Oral isotretinoin (systemic retinoid indicated in severe papulopustular acne refractory to conventional treatments, under strict medical and reproductive control).
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