In simpler words, we speak of folliculitis to indicate the classic pimples that can originate in any area of the skin covered by more or less evident hairs (or in any point of the epidermis, except for the palms of the hands and the soles of the feet).
Brief anatomical reference on the hair follicle
Human skin is covered with over 5 million hair follicles: these are tiny epidermal structures buried in the dermis, each of which is made up of a hair and its sheaths.
While the portion that emerges from the skin is called auction (or hair shaft), the one that sinks into the skin is known as root.
Attached to each hair follicle is a sebaceous gland, which pours its contents into it. On the back, however, is the erector hair muscle which is activated in response to thermal stimuli (cold) or strong emotions (fear), precisely erecting the hair shaft and giving rise to the so-called goose skin.
The follicle also consists of the bulb, which in turn houses the dermal papilla, an essential anatomical element for vascularizing the follicle.
We talk about folliculitis when one or more of these anatomical structures undergoes an infectious insult.
The most common form of infectious folliculitis is, in all likelihood, the one sustained by the beating Staphylococcus aureus. This microorganism is a saprophyte present in the skin and mucous membranes which - under normal conditions - does not cause damage. However, in some cases, it can proliferate in an uncontrolled way giving rise to different types of infections, among which we find folliculitis.
Still, the list of potential causes appears to be quite long.
Listed below are some possible risk elements (or, in some cases, triggers) for folliculitis.
- Excessive sweating
- Occlusion of the hair follicles induced by the frequent use of tight-fitting clothes;
- Shaving, especially if done against the hair;
- Presence of skin lesions;
- Dermatosis or other skin conditions;
- Immunosuppression (in this case, what is defined as "eosinophilic folliculitis" is generated, particularly widespread in AIDS patients, but which can occasionally also occur in healthy individuals);
- Diabetes mellitus;
- Obesity;
- Stings or insect bites.
In many patients, unfortunately, the main cause of follicle infection - especially in its relapsing form - still remains an unsolved question (idiopathic nature of the disorder).
In some cases, however, the triggering causes of folliculitis may not be of bacterial, fungal or viral origin. Therefore, in this type of situation, we speak of "non-infectious folliculitis". Examples of non-infectious folliculitis are:
- "Petroleum" or "oil" folliculitis: is an "inflammation of the hair follicles caused by" exposure to petroleum-derived mineral oils. It typically occurs in the forearms and mostly affects refinery workers or road maintenance workers.
- Beard pseudofolliculitis: it is a type of folliculitis that occurs when hair penetrates the skin before it even leaves the hair follicle. Doing so creates irritation and inflammation from a foreign body, which results in the formation of "pimples" typical of folliculitis which, however, are not triggered by a "bacterial infection.
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It has been observed that patients with iron deficiency anemia are statistically more exposed to the risk of chronic folliculitis.
male is constantly subject to shaving, in men folliculitis tends to manifest itself mainly in the beard area. In women, however, the same disorder occurs more frequently in the skin of the arms, legs and buttocks.Superficial folliculitis - the most common form - begins with red boils and / or small pus-filled pustules near the follicles. The size of the pustules depends on the depth of the infection and the extent of the damage.
Sometimes, on the skin affected by folliculitis, small purulent vesicles with the classic yellow cap can also be observed which, when bursting, leave small crusts.
While skin redness and itching are recurrent symptoms in the context of superficial folliculitis, pain and scar formation occur when folliculitis involves the deeper layers of the skin.
To summarize briefly, folliculitis - which can occur in any area of the skin covered with hair - manifests with signs and symptoms such as:
- Red boils;
- Small pus-filled pustules
- Small purulent vesicles which, once burst, leave crusts;
- Itching;
- Redness of the skin;
- Small scars;
- Ache.
Superficial folliculitis
Superficial folliculitis requires careful body hygiene and the exclusive use of neutral and extremely delicate soaps.
Infectious folliculitis
As previously mentioned, infectious folliculitis can be triggered by different types of microorganisms, such as bacteria, viruses or fungi. Therapy for each of these infections therefore varies according to the triggering pathogen.
The main infectious folliculitis and the therapies needed to treat them will be briefly described below.
Deep or refractory lesions
Refractory or deep lesions, especially in the case of suspected ongoing infection, require a diagnostic assessment: in such circumstances, topical / oral administration of antibiotics is the most adequate treatment.
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The Staphylococcus aureus it is quite resistant to the action of penicillin; for this reason, infectious folliculitis caused by this pathogen is generally treated with other antibiotics such as dicloxacillin, rifampicin or a cephalosporin.
The microorganisms resistant to methicillin can instead be eradicated with clindamycin, minocycline or the combination of trimethoprim and sulfamethoxazole.
Pseudomonas-borne folliculitis
Folliculitis sustained by Pseudomonas are generally self-limiting and do not always require pharmacological intervention. However, when the patient has a weakened immune system, oral treatment with ciprofloxacin is recommended.
Folliculitis due to Gram-negative bacteria
It is a particular type of folliculitis that usually occurs in the case of antibiotic therapies against acne over time. The treatment of this type of folliculitis involves the use of antibiotics effective against Gram-negative microorganisms topically or orally, second doctor's opinion.
Naturally, the antibiotics to be used will have to be different from those previously used for the treatment of acne, whose long-term use has given rise to folliculitis.
Herpetic Folliculitis
Herpetic folliculitis (therefore, of viral origin) is generally removed with antivirals such as valaciclovir, famciclovir, or aciclovir.
Fungal folliculitis
Infections to the follicles sustained by fungi are instead eradicated with antifungals such as fluconazole and "econazole: the peculiarity of fungal folliculitis is the tendency to relapse. For this reason, affected patients should continue topical (local) therapy with antifungal drugs even afterwards. the disappearance of symptoms.
Non-infectious folliculitis
Non-infectious variants of folliculitis do not require antibiotics, antifungals or antivirals. Depending on the cause, patients with these infections are treated with topical or systemic administration of cortisone.
Immunocompromised patients affected by non-infectious folliculitis may benefit from the administration of immunostimulating drugs possibly associated with a cortisone treatment.
Phototherapy is a sometimes effective alternative intervention for the treatment of non-infectious folliculitis.
Read also: Folliculitis Remedies
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