Folliculitis

Last reviewed: 26 Aug 2022
Last updated: 10 Nov 2021

Summary

Definition

History and exam

Key diagnostic factors

  • recent history of immersion in spa water
  • new medication commenced known to be associated with folliculitis
More key diagnostic factors

Other diagnostic factors

  • recent history of shaving
  • umbilicated, flesh-colored papules
  • papules on one side of the face in the submaxillary area
  • small, uniform papules and pustules
  • background erythema
  • alopecia/scalp scaling
  • erythematous plaques with hemorrhagic crusts in a dermatomal distribution
Other diagnostic factors

Risk factors

  • trauma, including shaving and extraction
  • topical corticosteroid preparations
  • diabetes mellitus
  • immunosuppression
  • occlusion and perspiration
  • systemic antibiotics
  • immersion in under-chlorinated water
  • drugs
More risk factors

Diagnostic investigations

Investigations to consider

  • bacterial skin swab
  • viral skin swab
  • skin scraping for mycology
  • tissue culture
  • skin biopsy
More investigations to consider

Treatment algorithm

INITIAL

uncomplicated superficial folliculitis, organism unknown

ACUTE

recurrent/deep folliculitis due to methicillin-susceptible Staphylococcus aureus (MSSA)

recurrent/deep folliculitis due to methicillin-resistant Staphylococcus aureus (MRSA)

gram-negative folliculitis

hot tub folliculitis due to Pseudomonas aeruginosa infection

dermatophytic folliculitis

Malassezia furfur (Pityrosporum folliculitis)

Candida folliculitis

HSV folliculitis

Demodex folliculorum folliculitis

drug-induced folliculitis

eosinophilic pustular folliculitis (Ofuji disease)

HIV-associated eosinophilic folliculitis

eosinophilic pustular folliculitis in infancy

Contributors

Authors

Joshua Hekmatjah, BS

Clinical Research Fellow

Dermatology Department

Keck School of Medicine of USC

University of Southern California

Los Angeles

CA

Disclosures

JH declares that he has no competing interests.

Nazanin Ehsani-Chimeh, MD

Clinical Research Fellow

Dermatology Department

Keck School of Medicine of USC

University of Southern California

Los Angeles

CA

Disclosures

NEC declares that she has no competing interests.

April W. Armstrong, MD, MPH
April W. Armstrong

Associate Dean, Clinical Research

Associate Professor of Dermatology

Keck School of Medicine of USC

University of Southern California

Los Angeles

CA

Disclosures

AWA has served as an investigator for Abbvie, Bristol-Myers-Squibb, Dermavent, Janssen, Eli Lilly, Modernizing Medicine, Novartis, OrthoDermalogics, Pfizer, Regeneron Pharmaceuticals, Sanofi Genzyme, and Sun Pharma; has been a speaker for Abbvie, Regeneron, and Sanofi Genzyme; and is a member of the data safety monitoring board for Boehringer Ingelheim/Paraxel. Her institution has received funding from Bristol-Myers-Squibb, Dermavent, Dermira, Eli Lilly, Galderma, Janssen-Ortho, Kyowa Hakko Kirin, Leo Pharma, Pfizer, and UCB Pharma.

Acknowledgements

Joshua Hekmatjah, Dr Nazanin Ehsani-Chimeh, and Dr April W. Armstrong would like to gratefully acknowledge Professor Howard Baden, a previous contributor to this topic.

Disclosures

HB declares that he has no competing interests.

Peer reviewers

Lowell Goldsmith, MD

Professor of Dermatology

Dean Emeritus

School of Medicine and Dentistry

University of North Carolina

Chapel Hill

NC

Disclosures

LG is editor-in-chief and co-founder of Logicalimages, Inc, which has print and electronic products for education and point-of-care; he has stock and stock options in that corporation. He is on the clinical and scientific advisory boards of Anacor Inc, which is developing anti-inflammatory and anti-infective products that are in early clinical trials; he receives payments and stock options for those services.

Dedee F. Murrell, MA, BMBCh, FAAD, MD

Head of Department

Department of Dermatology

St George Hospital

Conjoint Professor

University of New South Wales

Sydney

Australia

Disclosures

DFM declares that she has no competing interests.

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