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Folliculitis, Furuncles And Carbuncles

Folliculitis is the name given to a group of skin conditions in which there are inflamed hair follicles. The result is a tender red spot, often with a surface pustule. Folliculitis can be due to infection, occlusion, irritation and specific skin diseases.

A bacterial infection of the hair follicle, folliculitis causes the formation of a pustule. The infection can be superficial (follicular impetigo or Bockhart's impetigo) or deep (sycosis barbae).

Furuncles, commonly known as boils, are another form of deep folliculitis. Carbuncles are a group of interconnected furuncles. The prognosis depends on the severity of the infection and the patient's physical condition and ability to resist infection.

Causes

The most common cause of folliculitis, furuncles, or carbuncles is coagulasepositive Staphylococcus aureus. Predisposing factors include an infected wound, poor hygiene, debilitation, tight clothes, friction, and immunosuppressive therapy.

Barber's itch is a staph infection of the hair follicles in the beard area of the face, usually the upper lip. Shaving aggravates the condition. Tinea barbae is similar to barber's itch, but the infection is caused by a fungus.

Pseudofolliculitis barbae is a disorder occurring primarily in black men. If curly beard hairs are cut too short, they may curve back into the skin and cause inflammation.

Signs and symptoms

Folliculitis, furuncles, and carbuncles have different signs and symptoms.

• Folliculitis pustules usually appear on the scalp, arms, and legs in children and on the trunk, buttocks, and legs in adults.
• Furuncles are hard, painful nodules that 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.
• Carbuncles are 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, which are now rather rare.

Diagnosis

The obvious skin lesion confirms folliculitis, furuncles, or carbuncles. Wound culture usually shows S. aureus. In carbuncles, patient history reveals preexistent furuncles. A complete blood count may show an elevated white blood cell count (leukocytosis).

Treatment

Appropriate treatment includes the following:

• Folliculitis is treated by cleaning the infected area thoroughly with antibacterial soap and water; applying warm, wet compresses to promote vasodilation and drainage from the lesions; applying topical antibiotics, such as mupirocin ointment or clindamycin or erythromycin solution; and, in extensive infection, administering systemic antibiotics (a cephalosporin or dicloxacillin).
• Furuncles may require incision and drainage of ripe lesions after application of warm, wet compresses and systemic antibiotics after drainage.
• Carbuncles require systemic antibiotic therapy as well as incision and drainage.

Prevention

Anyone who has a tendency to develop folliculitis should cleanse the skin with antibacterial soap twice a day and before shaving and should not use oily skin lotions. Men should not shave while the beard area is infected. When they begin shaving again, they should use a new blade each time. Women who have had fungal folliculitis should use depilatory creams instead of razors. Daily shampooing can help prevent folliculitis in the scalp. The spread of infection can be prevented by not sharing towels or wash cloths.