|Folliculitis represents inflammation of the hair follicles in areas of the body where these appendages are more prominent than the sebaceous glands. Hair follicles predominate over the sebaceous glands on the scalp, trunk, arms, and legs, as opposed to the face where the sebaceous glands are larger and more numerous, where acne develops rather than folliculitis. Inflammation of the follicles is characterized by redness around the pilo-sebaceous opening, papules, and sometimes pustules. The areas can become itchy and even painful.
The cause is usually bacterial in origin, either directly or indirectly. Common bacterial pathogens include Staphylococcus aureus or, in the case of folliculitis from soaking in a “hot tub,” Pseudomonas aeruginosa. Whether the bacteria cause the inflammation or the breakdown products from the bacteria create the problem is not always clear. Folliculitis may also develop, when grease or occlusive agents occlude the pilo-sebaceous opening, permitting the bacteria to flourish.
For these reasons, there are several different approaches to treatment: oral antimicrobials, topical antimicrobials, and/or topical corticosteroids. Adjunctive treatment, for example, may also include benzyl peroxide washes in the shower, but scrubbing the skin with a washcloth, loufa, or scrub brush may aggravate the problem. Folliculitis can wax and wane for some time.
Lawrence Charles Parish, MD, MD (Hon)