UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Infectious folliculitis

Author
Jeremy D Jackson, MD
Section Editor
Ted Rosen, MD
Deputy Editor
Abena O Ofori, MD

INTRODUCTION

Folliculitis refers to inflammation of the superficial or deep portion of the hair follicle. The classic clinical findings of superficial folliculitis are follicular pustules and follicular erythematous papules on hair-bearing skin. Nodules are a feature of deep follicular inflammation.

Folliculitis may be infectious or, less frequently, noninfectious. Various bacteria, fungi, viruses, and parasites are causes of infectious folliculitis.

The etiology, clinical manifestations, diagnosis, and management of infectious folliculitis will be reviewed here. Noninfectious causes, such as human immunodeficiency virus (HIV)-associated eosinophilic folliculitis and drug-induced folliculitis, are reviewed separately. (See "HIV-associated eosinophilic folliculitis" and "Acneiform eruption secondary to epidermal growth factor receptor (EGFR) inhibitors" and "Approach to the patient with pustular skin lesions".)

BACTERIAL FOLLICULITIS

Bacterial infection is the most common cause of infectious folliculitis.

Etiology and risk factors — Frequent causes of bacterial folliculitis include Staphylococcus aureus and gram-negative bacteria.

                         

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Oct 01 00:00:00 GMT+00:00 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Cohen PR. Community-acquired methicillin-resistant Staphylococcus aureus skin infections: implications for patients and practitioners. Am J Clin Dermatol 2007; 8:259.
  2. Yu Y, Cheng AS, Wang L, et al. Hot tub folliculitis or hot hand-foot syndrome caused by Pseudomonas aeruginosa. J Am Acad Dermatol 2007; 57:596.
  3. Teraki Y, Nakamura K. Rubbing skin with nylon towels as a major cause of pseudomonas folliculitis in a Japanese population. J Dermatol 2015; 42:81.
  4. Mazza J, Borkin M, Buchholz R, Deleo V. Pseudomonas folliculitis contracted from rubber gloves: a public health concern. J Am Acad Dermatol 2013; 69:e93.
  5. Kitamura M, Kawai S, Horio T. Pseudomonas aeruginosa folliculitis: a sporadic case from use of a contaminated sponge. Br J Dermatol 1998; 139:359.
  6. Neubert U, Jansen T, Plewig G. Bacteriologic and immunologic aspects of gram-negative folliculitis: a study of 46 patients. Int J Dermatol 1999; 38:270.
  7. Julià Manresa M, Vicente Villa A, Gené Giralt A, González-Enseñat MA. Aeromonas hydrophila folliculitis associated with an inflatable swimming pool: mimicking Pseudomonas aeruginosa infection. Pediatr Dermatol 2009; 26:601.
  8. Luelmo-Aguilar J, Santandreu MS. Folliculitis: recognition and management. Am J Clin Dermatol 2004; 5:301.
  9. Laureano AC, Schwartz RA, Cohen PJ. Facial bacterial infections: folliculitis. Clin Dermatol 2014; 32:711.
  10. Chiller K, Selkin BA, Murakawa GJ. Skin microflora and bacterial infections of the skin. J Investig Dermatol Symp Proc 2001; 6:170.
  11. Dessinioti C, Antoniou C, Katsambas A. Acneiform eruptions. Clin Dermatol 2014; 32:24.
  12. Lopez FA, Lartchenko S. Skin and soft tissue infections. Infect Dis Clin North Am 2006; 20:759.
  13. Williamson DA, Monecke S, Heffernan H, et al. High usage of topical fusidic acid and rapid clonal expansion of fusidic acid-resistant Staphylococcus aureus: a cautionary tale. Clin Infect Dis 2014; 59:1451.
  14. van Bijnen EM, Paget WJ, den Heijer CD, et al. Primary care treatment guidelines for skin infections in Europe: congruence with antimicrobial resistance found in commensal Staphylococcus aureus in the community. BMC Fam Pract 2014; 15:175.
  15. Bohaty BR, Choi S, Cai C, Hebert AA. Clinical and bacteriological efficacy of twice daily topical retapamulin ointment 1% in the management of impetigo and other uncomplicated superficial skin infections. Int J Womens Dermatol 2015; 1:13.
  16. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:e10.
  17. Böni R, Nehrhoff B. Treatment of gram-negative folliculitis in patients with acne. Am J Clin Dermatol 2003; 4:273.
  18. Jahns AC, Lundskog B, Berg J, et al. Microbiology of folliculitis: a histological study of 39 cases. APMIS 2014; 122:25.
  19. Durdu M, Güran M, Ilkit M. Epidemiological characteristics of Malassezia folliculitis and use of the May-Grünwald-Giemsa stain to diagnose the infection. Diagn Microbiol Infect Dis 2013; 76:450.
  20. Pedrosa AF, Lisboa C, Gonçalves Rodrigues A. Malassezia infections: a medical conundrum. J Am Acad Dermatol 2014; 71:170.
  21. Rubenstein RM, Malerich SA. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol 2014; 7:37.
  22. Gaitanis G, Velegraki A, Mayser P, Bassukas ID. Skin diseases associated with Malassezia yeasts: facts and controversies. Clin Dermatol 2013; 31:455.
  23. Rhie S, Turcios R, Buckley H, Suh B. Clinical features and treatment of Malassezia folliculitis with fluconazole in orthotopic heart transplant recipients. J Heart Lung Transplant 2000; 19:215.
  24. Ilkit M, Durdu M, Karakaş M. Majocchi's granuloma: a symptom complex caused by fungal pathogens. Med Mycol 2012; 50:449.
  25. Kapdağli H, Oztürk G, Dereli T, et al. Candida folliculitis mimicking tinea barbae. Int J Dermatol 1997; 36:295.
  26. Song HS, Kim SK, Kim YC. Comparison between Malassezia Folliculitis and Non-Malassezia Folliculitis. Ann Dermatol 2014; 26:598.
  27. Hald M, Arendrup MC, Svejgaard EL, et al. Evidence-based Danish guidelines for the treatment of Malassezia-related skin diseases. Acta Derm Venereol 2015; 95:12.
  28. Parsad D, Saini R, Negi KS. Short-term treatment of pityrosporum folliculitis: a double blind placebo-controlled study. J Eur Acad Dermatol Venereol 1998; 11:188.
  29. Bäck O, Faergemann J, Hörnqvist R. Pityrosporum folliculitis: a common disease of the young and middle-aged. J Am Acad Dermatol 1985; 12:56.
  30. Abdel-Razek M, Fadaly G, Abdel-Raheim M, al-Morsy F. Pityrosporum (Malassezia) folliculitis in Saudi Arabia--diagnosis and therapeutic trials. Clin Exp Dermatol 1995; 20:406.
  31. Lee JW, Lee HI, Kim MN, et al. Topical photodynamic therapy with methyl aminolevulinate may be an alternative therapeutic option for the recalcitrant Malassezia folliculitis. Int J Dermatol 2011; 50:488.
  32. Lee JW, Kim BJ, Kim MN. Photodynamic therapy: new treatment for recalcitrant Malassezia folliculitis. Lasers Surg Med 2010; 42:192.
  33. Oon HH, Lim KS, Chong WS, Tan SH. Erythematous and edematous eruption of the face. Herpes folliculitis. Int J Dermatol 2010; 49:973.
  34. Jang KA, Kim SH, Choi JH, et al. Viral folliculitis on the face. Br J Dermatol 2000; 142:555.
  35. Feldmeyer L, Kamarashev J, Boehler A, et al. Molluscum contagiosum folliculitis mimicking tinea barbae in a lung transplant recipient. J Am Acad Dermatol 2010; 63:169.
  36. Lee B, Kang HY. Molluscum folliculitis after leg shaving. J Am Acad Dermatol 2004; 51:478.
  37. Böer A, Herder N, Winter K, Falk T. Herpes folliculitis: clinical, histopathological, and molecular pathologic observations. Br J Dermatol 2006; 154:743.
  38. Campanelli A, Marazza G, Stucki L, et al. Fulminant herpetic sycosis: atypical presentation of primary herpetic infection. Dermatology 2004; 208:284.
  39. Al-Dhafiri SA, Molinari R. Herpetic folliculitis. J Cutan Med Surg 2002; 6:19.
  40. Salem DA, El-Shazly A, Nabih N, et al. Evaluation of the efficacy of oral ivermectin in comparison with ivermectin-metronidazole combined therapy in the treatment of ocular and skin lesions of Demodex folliculorum. Int J Infect Dis 2013; 17:e343.
  41. Rusiecka-Ziółkowska J, Nokiel M, Fleischer M. Demodex - an old pathogen or a new one? Adv Clin Exp Med 2014; 23:295.
  42. Elston DM. Demodex mites: facts and controversies. Clin Dermatol 2010; 28:502.
  43. Brown M, Hernández-Martín A, Clement A, et al. Severe demodexfolliculorum-associated oculocutaneous rosacea in a girl successfully treated with ivermectin. JAMA Dermatol 2014; 150:61.
  44. Elston CA, Elston DM. Demodex mites. Clin Dermatol 2014; 32:739.
  45. Chen W, Plewig G. Human demodicosis: revisit and a proposed classification. Br J Dermatol 2014; 170:1219.
  46. Forton F, Seys B, Marchal JL, Song AM. Demodex folliculorum and topical treatment: acaricidal action evaluated by standardized skin surface biopsy. Br J Dermatol 1998; 138:461.