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Types of bacterial folliculitis introduction
Impetigo
Hot tub folliculitis
Bacterial sycosis
Gram-negative bacterial folliculitis
Types of bacterial folliculitis references
Types
of bacterial folliculitis introduction
Simply put, folliculitis is an inflammation of
the hair follicles. All hair on the human body grows from hair
follicles (also called pilosebaceous units), which are present
everywhere except on the palms of the hands, soles of the feet
and mucous membranes. The pilosebaceous unit of the hair follicle
is divided into three parts, the infundibulum or the superficial
part including the sebaceous gland, the isthmus (middle segment
bounded by the sebaceous gland duct and arrector pili muscle),
and the inferior part, which comprises of the stem and hair bulb.
When there is an inflammatory reaction arising out of an obstruction
of the sebaceous gland in the superficial aspect of the hair follicle,
the condition is called folliculitis.
Folliculitis (Inflammation of a follicle) is more common in areas
of the skin where short, coarse hair grows. Because the provoking
factor often occurs over a fairly large patch of skin, groups
of follicles are most often affected in clusters.
Folliculitis is classified as infectious folliculitis or non-infectious
folliculitis. To simplify the spectrum of folliculitis, infectious
folliculitis is further classified as Bacterial Folliculitis,
Syphilitic Folliculitis, Fungal Folliculitis, Viral Folliculitis
and Parasitic Folliculitis, depending on the pathogen responsible
for the infection.
Predisposing factors leading to the incidence of bacterial folliculitis
include:
-
Nasal carriage of Staphylococcus Aureus
-
Occlusion
(something covering the hair follicle openings in the skin)
-
Maceration (the skin is constantly wet which
makes it softer and it turns white in Caucasians)
-
Hyperhydration
(an excess of body water)
-
Complicated itchy skin diseases
such as scabies or eczema
-
Vigorous application of corticosteroids
-
Shaving
against the direction of hair growth
-
Exposure to certain
oils and chemicals
-
Pin worm infestation
-
Exposure to heated water
or contaminated water
Some superficial fungal infections are easily self-treated. However,
bacterial infections, which encompass impetigo, furuncles (boils),
carbuncles and “hot tub” folliculitis do not resolve
spontaneously and generally require prescription therapy.
Impetigo
Bacterial folliculitis may be superficial or deep in the hair
follicles. Superficial folliculitis, also called impetigo, is
a superficial infection of the skin characterized by thin-walled
vesicles and bullae that readily rupture, forming lightly adherent
yellowish crusts. Both vesicles and bullae are noncystic transparent,
fluid-filled elevations in the skin; vesicles are less than
1 cm diameter; bullae are greater than 1 cm diameter. So they
are essentially the same thing, only different sizes.
Bockhart impetigo is caused by hemolytic streptococci, that
are destructive to red blood cells, or Staphylococcus aureus,
and often involves the face, buttocks, and under arm axillae
particularly in infants and children from 2 to 5 years of age.
The legs in adolescent girls and the flexural areas such as
the buttocks, groin, and armpits in adolescent boys may also
be affected. Because of the superficial nature of the process,
involvement of the scalp rarely leads to scarring, although
temporary loss of hair may occur.
Impetigo (an acute contagious staphylococcal or streptococcal
skin disease) is classified as bullous or non-bullous. The non-bullous
type is more prevalent and is characterized by clusters of erosions
and as well as vesicles or pustules that have a honey yellow
crust. The bullous form presents as large thin walled bullae
containing a serum-like yellow liquid. Often, more than one
area can be involved and a mix of bullous as well as non-bullous
findings may be present.
At one time, non-bullous impetigo was thought to be a group ‘A’ streptococcal
process, but research and studies indicate that both forms of
impetigo are caused by S. Aureus, with involvement of streptococcus
in the non-bullous form. Impetigo can be spread by person-to-person
contact, so appropriate rules of hygiene must be adhered to.
Nasal carriage of S. Aureus has been implicated as a cause of
recurrence.
Clinical features
Bockhart impetigo manifests as small blisters filled with pus
known as pustules, often surrounded by a ring of erythema or
redness and located within follicular orifices. The pustules,
normally with a hair in the center, develop in clusters and
form crusts as the condition progresses. The lesions vary in
size from 1 to 6 mm and may involve other parts of the body.
The pustules, which can be quite itchy, usually heal in a few
days but sometimes develop into furuncles as a result of the
spread of the infection further into the hair follicle.
Pathology
Impetigo of Bockhart starts in the ostia or openings of the
follicle and then extends downwards deeper into the hair follicle.
Pathologically, a pustule in the ostia of the follicles is seen.
There may be dilatation of vessels in the dermis and perivascular
accumulation of inflammatory cells. The causative agent is Staphylococcus
aureus, which may be cultured from the pus.
Treatment
Treating impetigo involves one or a combination of the following:
-
Topical treatments include antibiotics such
as mupirocin or fusidic acid ointment. In severe cases,
topical steroids
may be used to reduce the inflammation.
-
Physical treatments like gentle removal
of crusts ensure that treatments that are put directly
onto the skin will be more effective rather than
being applied on top of the crust.
-
Systemic treatment is ordinarily
used for the large, more aggressive, infections. After
obtaining a culture and characterizing
the particular bacteria involved in the infection, the patients are typically
started
on erythromycin - or penicillinase-resistant penicillin in appropriate
dosage. Intravenous
antibiotics
are often used initially for the more severe cases.
-
To
eliminate skin colonization caused by staphylococcal
infection, a daily 5- minute bath with Oilatum,
a liquid paraffin
compound with moisturizing and antiseptic properties, is effective.
-
To eliminate
clothing contamination, the patient’s
clothing, bed and bath linen should, as a
common practice,
be
washed in hot water.
-
Predisposing factors
leading to the infection should be identified
and treated.
Hot
tub folliculitis
“Hot Tub” Folliculitis
is a condition caused by the pathogen Pseudomonas aeruginosa,
and is often seen
where spa sanitation is at fault. Pseudomonas survives in
hot water unless the pH and chlorine content are strictly
controlled and are commonly found in contaminated whirlpools,
hot tubs, water slides, swimming and physiotherapy pools.
Clinical Features
Hot Tub folliculitis manifests as multiple pustular (blisters
with pus) or perifollicular lesions on the trunk and extremities
within 6 to 72 hours after exposure to the pathogen. The lesions
first appear as itchy bumps, and then develop into dark red
tender nodules. The rash may be denser under swimsuit areas,
where the material has held the contaminated water in contact
with the skin for a longer period. The rash may be accompanied
by fever and malaise.
Differential Diagnosis
Physical examination combined with a history of recent hot
tub use is sufficient for the dermatologist to make a correct
diagnosis.
Treatment
Treatment may not be needed, as the mild form of the disease
usually clears up on its own. Oral or topical anti-pruritic
(anti-itch) medications may be advised. In severe cases, oral
antibiotics may be required.
In the case of Hot Tub folliculitis, prevention is better
than cure, and treatment should be directed at preventing
the condition by appropriately cleaning the whirlpool or hot
tub and maintaining appropriate chlorine levels in the water.
Bacterial Sycosis is a deep, chronic staphylococcal infection
that involves the entire hair follicle. This condition is mostly
seen in males after puberty, predominantly in the third and
fourth decades of life. The lesions begin with an inflammatory
follicular papule or pustule with edema (water retention) located
in the beard, accompanied by a burning sensation. Gradually
more pustules develop and eventually coalesce into scaly patches
or plaques studded with pustules. The chronic form may go on
for years and in severe cases the follicles are completely destroyed
with scarring.
Gram-negative
bacterial folliculitis
Gram-negative folliculitis is another kind of deep folliculitis
that sometimes develops in people receiving long-term antibiotic
treatment for acne. The pathogens identified include Klebsiella,
Enterobacter, and Proteus species. Antibiotics used routinely
in the therapy of acne alter the normal balance of bacteria in
the nose, leading to an overgrowth of harmful organisms (Gram-negative
bacteria). In most people, this does not have any side effects.
However, in some cases Gram-negative bacteria spread to the cheeks,
chin and jaw line, where they cause new and severe acne lesions.
Treatment involves the identification and elimination of the
source of the Gram-negative infection. The condition can be treated
with isotretinoin, a chemical compound which acts by inhibiting
the secretion of sebum. The side effects of the use of isotretinoin
must be considered before commencing treatment.
Types
of bacterial folliculitis references
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15554731
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