Folliculitis

Background

• Inflammation of the hair follicle
• Secondary to infection, trauma, or occlusion

Clinical Features

• Papules and pustules on an erythematous base
• Located around a hair follicle
• Pruritus or mild discomfort

Differential Diagnosis

Skin and Soft Tissue Infection

• Cellulitis
  • Hand cellulitis
  • Facial cellulitis
  • Orbital cellulitis
• Erysipelas
• Lymphangitis
• Folliculitis
• Hidradenitis suppurativa
• Skin abscess
  • Anorectal abscess
  • Bartholin gland abscess
  • Pilonidal abscess
  • Scrotal abscess
• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
  • Fournier's gangrene
• Mycobacterium marinum

Look-A-Likes

• Sporotrichosis
• Osteomyelitis
• Deep venous thrombosis
• Pyomyositis
• Purple glove syndrome
• Tuberculosis (tuberculous inflammation of the skin)

Vesiculobullous rashes

Febrile

• Diffuse distribution
  • Varicella (chickenpox)
  • Smallpox
  • Monkeypox
  • Disseminated gonococcal disease
  • DIC
  • Purpural fulminans
• Localized distribution
  • Necrotizing fasciitis
  • Hand-foot-and-mouth disease

Afebrile

• Diffuse distribution
  • Bullous pemphigoid
  • Drug-Induced bullous disorders
  • Pemphigus vulgaris
  • Phytophotodermatitis
  • Erythema multiforme major
  • Bullous impetigo
• Localized distribution
  • Contact dermatitis
  • Herpes zoster (shingles)
  • Dyshidrotic eczema
  • Burn
  • Dermatitis herpetiformis
  • Erythema multiforme minor
  • Poison Oak, Ivy, Sumac dermatitis
  • Bullosis diabeticorum
  • Bullous impetigo
  • Folliculitis

Evaluation

• Clinical diagnosis

Management

• Superficial folliculitis
  • Antibacterial soaps, good hygiene
  • Warm compress
• Deep folliculitis
  • Incision and drainage
  • Antibiotics covering MRSA

Disposition

• Discharge
• Outpatient management