What is Folliculitis and Acneiform Dermatoses?
Folliculitis is a group of skin conditions characterized by the inflammatory cells that affect the wall and Ostia of the hair follicle, creating follicular-based pustule and pus formation. Acneiform dermatoses are acne lesions (follicular eruptions) that may be cystic, nodular, or papulopustular, which develop as a result of follicular epidermal hyperproliferation, increased sebum production, and follicular irritation.
What Causes Folliculitis and Acneiform Dermatoses?
The onset and development of folliculitis and acneiform dermatoses (FCAD) is associated with infections caused by bacteria, virus, parasites, and yeast or fungus. Non-infectious causes of FCAD involve several environmental factors that commonly activate the autoimmune processes leading to inflammation, occlusion or follicular trauma such as exposure to toxic chemicals.
Who is at Risk?
FCAD may occur in persons of all ages, sex, and race around the world. However, 50-100% of patients have acneiform dermatoses caused by a dose-dependent drug reaction and attributed to epidermal growth factor receptor inhibitors. In terms of race, eosinophilic folliculitis is more common among Japanese while African Americans are more commonly affected by pseudofolliculitis and traction folliculitis. Males are more at risk of eosinophilic folliculitis while females are often vulnerable to pityrosporum folliculitis .
People who have greater risks of FCAD include those with immunosuppressed body immune system from infections such as HIV, cancer, and diabetes. It also involves people with poor personal hygiene, ineffective cleansing habits, wearing tight clothes, frequent razor shaving, infected cut, surgical wound, and exposure to skin irritants such as chlorine, the use of makeup, machine oils, and accumulation of sweat that may block, injure, irritate, and inflame the follicles [2, 3].
The clinical signs and symptoms of FCAD are typically manifested as inflammatory follicular lesions that initially appear as small red, itchy, tender, and painful pustules, which occasionally contain pus surrounding the hair. Comedones (blackheads) develop as secondary lesions from the older lesions that have lost the pus, in which the skin is more vulnerable to other skin infections such as contact dermatitis, keratosis pilaris or depigmentation.
Although inflammatory lesions affecting the scalp are rare, scarring types of folliculitis may result in permanent hair loss. Most of the follicular rashes appear frequently in areas of the body with hair follicles such as the face, scalp, chest, or groin, and less common in the thighs or buttocks. It does not affect the soles, palms, eyelids or other body parts devoid of hair follicles.
The distribution patterns of lesions and patient’s age are characteristics that provide strong evidence about the etiology of skin pustular eruptions to help the dermatologist or allergist diagnose folliculitis and acneiform dermatoses. Skin patch and blood test are performed as part of differential diagnosis to identify the specific cause of FCAD and rule out several allergic skin infections with similar symptoms such as contact dermatitis, psoriasis, acne vulgaris, depigmentation, or keratosis pilaris.
Treatment and Prevention
There are several treatment options recommended depending on the specific cause of FCAD. Generally, topical corticosteroid creams and ointments are used to prevent further skin itching and reduce inflammations. Antibiotics may be prescribed in mild cases of suspected bacterial, fungal or yeast folliculitis using topical antibacterial and antifungal creams (clindamycin, metronidazole, and miconazole) or oral medications such as doxycycline, ciprofloxacin, or fluconazole pills.
Personal routine hygiene and skin care practices are essential prevention measures against FCAD, especially the non-infectious causes. This involves strict avoidance to various skin allergens or irritants associated with exposure to toxic chemicals, drugs, various synthetic fabrics, or physical irritation of skin and hair follicles via aggressive scrubbing/shaving. You should avoid visiting unhygienic pools and hot tubs; regularly change razor blades, avoid sharing razors, and shaving too closely to the skin; and keep your skin moist. You should also ensure that you purchase and wear hypo-allergic clothing from textile industries that deal with only 100% natural organic textile materials such as cotton.
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Clio, D., Christina, A., & Andreas, K. Acneiform Eruptions. Clinics In Dermatology, April 2014; 32(1) p.24-34
Cole, G. (June, 2017). Folliculitis. Retrieved 2nd, September 2017 from http://www.medicinenet.com/folliculitis/article.htm
Kam Har, M. (September 2002). Differential Diagnoses of Acneiform Eruptions. Medical Section, 7 (7) p. 3-11. Retrieved 2nd, September 2017 from http://www.fmshk.org/article/806.pdf
Kuflik, J. K et al. February, 2016). Acneiform Eruptions. Retrieved 2nd, September 2017 from http://emedicine.medscape.com/article/1072536
WebMD. (2015). Folliculitis-Topic Overview. Retrieved 2nd, September 2017 from http://www.webmd.com/skin-problems-and-treatments/tc/folliculitis-topic-overview#1