Folliculitis - Anogenital in
See also in: Overview,Hair and ScalpAlerts and Notices
Synopsis
The etiology of folliculitis can be variable, with bacterial, fungal, viral, parasitic, and noninfectious causes reported. A detailed history of comorbid conditions, exposures, and medications, in conjunction with appropriate ancillary testing, can be helpful.
In immunocompetent patients, bacterial folliculitis may be considered, often due to a predisposing factor that allows for increased bacterial burden on the skin surface. Staphylococcus aureus and Streptococcus species are commonly implicated. These predisposing factors include nasal carriage of S. aureus, occlusion, maceration, hyperhydration, complicating pruritic skin diseases, vigorous application of topical medications, shaving, exposure to oils and certain chemicals, and exposure to heated or contaminated water.
In the genital area, in particular, shaving or other methods of hair removal may result in pseudofolliculitis from ingrown hairs or true bacterial folliculitis. Infection may result due to autoinoculation, contamination of tools, normal skin flora, or colonization of the individual performing the procedure. Pustular folliculitis secondary to Candida spp. (see candidiasis) has also been reported in immunocompetent adults, particularly in skin folds. Viral folliculitis secondary to varicella zoster virus, herpes simplex virus, and molluscum contagiosum have been described.
In immunocompromised patients, folliculitis can occur secondary to etiologies similar to those discussed above. For example, bacterial folliculitis may evolve into furunculosis, or inflammation involving deeper aspects of the pilosebaceous unit, in patients with certain risk factors such as diabetes mellitus, immunosuppression, or human immunodeficiency virus (HIV) infection.
Codes
ICD10CM:L73.8 – Other specified follicular disorders
SNOMEDCT:
13600006 – Folliculitis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Molluscum contagiosum in the pubic area is often mistaken for folliculitis. A correlation has been noted between pubic hair removal and sexually transmitted molluscum contagiosum.
- Insect bites
- Flat warts
- Condyloma acuminatum
- Milia
- Candidiasis
- Ingrown hairs
- Eosinophilic folliculitis (seen in AIDS)
- Herpes simplex
- Herpes zoster
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:03/01/2017
Last Updated:08/16/2021
Last Updated:08/16/2021
Patient Information for Folliculitis - Anogenital in
Overview
Folliculitis is a skin condition caused by an inflammation of one or more hair follicles. It typically occurs in areas of irritation, such as sites of shaving, skin friction, or rubbing from clothes. In most cases of folliculitis, the inflamed follicles are infected with bacteria, especially with Staphylococcus (or "staph") organisms, that normally live on the skin. Bacteria such as Pseudomonas may live in hot tubs, spas, and swimming pools and may also cause folliculitis.Who’s At Risk
Folliculitis occurs in people of all ages, races / ethnicities, and sexes.Further risk factors for folliculitis include:
- Diabetes.
- A suppressed immune system due to HIV, organ transplantation, or cancer.
- An underlying skin condition, such as eczema, acne, or another inflammation of the skin (dermatitis).
- Obesity.
- Frequent shaving.
- Pressure (eg, prolonged sitting on the buttocks).
Signs & Symptoms
The most common locations for folliculitis include the:- Scalp.
- Buttocks.
- Thighs.
- Areas that are shaved, such as the beard area, underarms, groin, and legs.
Mild and moderate cases of folliculitis are often tender and itchy. More severe cases of folliculitis, which may be deeper and may affect the entire hair follicle, can be painful.
Mild and moderate cases of folliculitis usually clear up quickly with treatment and leave no scars. More severe cases of folliculitis may lead to complications such as cellulitis (an infection of the deeper skin tissue), scarring, and permanent hair loss in the affected area.
Self-Care Guidelines
To prevent folliculitis:- Shave in the same direction of hair growth.
- Avoid shaving irritated skin.
- Use an electric razor or a new disposable razor each time you shave.
- Avoid tight, constrictive clothing, especially during exercise.
- Wash athletic wear after each use.
- Consider other methods of hair removal, such as depilatories.
- Use an antibacterial soap or wash (eg, PanOxyl Acne Creamy Wash, Hibiclens).
- Launder towels, washcloths, and bed linens frequently, and do not share such personal items with others.
- Wear loose-fitting clothing.
When to Seek Medical Care
Make an appointment to be evaluated by a dermatologist or another medical professional if the above self-care measures do not resolve the condition within 2-3 days, if symptoms come back frequently, or if the infection spreads.Be sure to tell the medical professional about any recent exposure to hot tubs, spas, and swimming pools, as a less common form of folliculitis may be caused by contamination from these water sources.
If you are currently being treated for a skin infection that has not improved after 2-3 days of antibiotics, return to your medical professional.
Treatments
Folliculitis is fairly easy to diagnose in most cases. Your medical professional may perform a bacterial culture to determine the cause of the folliculitis and may recommend:- Antibacterial wash, such as chlorhexidine (eg, Betasept, Hibiclens).
- Topical antibiotic lotion or gel, such as erythromycin (eg, AkneMycin) or clindamycin (eg, Cleocin T).
- Oral antibiotic pills, such as cephalexin (eg, Keflex) or doxycycline (eg, Vibramycin, Monodox), or ciprofloxacin (eg, Cipro) in the case of hot tub folliculitis.
- A combination of two different oral antibiotics, including trimethoprim-sulfamethoxazole (eg, Bactrim), clindamycin (eg, Cleocin), amoxicillin (eg, Amoxil), linezolid (eg, Zyvox), or tetracycline.
Folliculitis - Anogenital in
See also in: Overview,Hair and Scalp