Folliculitis is a bacterial infection of the hair follicle that causes the formation of a pustule. The infection can be superficial (follicular impetigo or Bockhart’s impetigo) or deep (sycosis barbae). Folliculitis may also lead to the development of furuncles (furunculosis), commonly known as boils, or carbuncles (carbunculosis), which involve multiple contiguous hair follicles. The prognosis depends on the severity of the infection and on the patient’s physical condition and ability to resist infection.
The most common cause of folliculitis, furunculosis, or carbunculosis is coagulase-positive Staphylococcus aureus. Predisposing factors include an infected wound, poor hygiene, debilitation, diabetes, alcoholism, occlusive cosmetics, tight clothes, friction, chafing, exposure to chemicals, and treatment for skin lesions with tar or with occlusive therapy, using steroids. Furunculosis often follows folliculitis exacerbated by irritation, pressure, friction, or perspiration. Carbunculosis follows persistent S. aureus infection and furunculosis.
Pustules of folliculitis usually appear in a hair follicle on the scalp, arms, and legs in children; on the face of bearded men (sycosis barbae); and on the eyelids (styes). Deep folliculitis may be painful.
Folliculitis may progress to the hard, painful nodules of furunculosis, which commonly develop on the neck, face, axillae, and buttocks. For several days these nodules enlarge, and then rupture, discharging pus and necrotic material. After the nodules rupture, pain subsides, but erythema and edema may persist for days or weeks.
Carbunculosis is marked by extremely painful, deep abscesses that drain through multiple openings onto the skin surface, usually around several hair follicles. Fever and malaise may accompany these lesions. (See Follicular skin infections.)
In carbunculosis, patient history reveals preexistent furunculosis. A complete blood count may reveal an elevated white blood cell count (leukocytosis).
Treatment for folliculitis consists of cleaning the infected area thoroughly with antibacterial soap and water or benzoyl peroxide; applying warm, wet compresses to promote vasodilation and drainage from the lesions; topical antibiotics such as mupirocin ointment and, in extensive infection or if a furuncle or carbuncle has developed, systemic antibiotics. Use sensitivity results to guide therapy, but begin treatment before receiving results.
Furunculosis and carbunculosis may also require incision and drainage of ripe lesions if the lesions don’t drain after the application of warm, wet compresses. They may also require topical antibiotics after drainage.
Care for patients with folliculitis, furunculosis, and carbunculosis is basically supportive and emphasizes teaching the patient scrupulous personal and family hygiene measures. Taking the necessary precautions to prevent spreading infection is also an important part of care.
❑ Caution the patient never to squeeze a boil because this may cause it to rupture into the surrounding area.
❑ To avoid spreading bacteria to family members, urge the patient not to share towels and washcloths. Tell him that these items should be laundered in hot water before being reused. The patient should change his clothes and bedsheets daily, and these also should be washed in hot water. Encourage the patient to change dressings frequently and to discard them promptly in paper bags.
❑ Advise the patient with recurrent furunculosis to have a physical examination because an underlying disease, such as diabetes or human immunodeficiency virus, may be present.
In blacks, trauma resulting from such hairstyles as cornrowing (gathering the hair into tight braids or tufts) can cause folliculitis.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Title: Professional Guide to Diseases (Eighth Edition)
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2005
ISBN: 1-58255-370-X
» Next page: Folliculitis, furuncles, and carbuncles (Handbook of Diseases)
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