In general, folliculitis presents with the following common cutaneous symptomatology among patients:

• Clustering of red bumps in a skin region
• Pustule formation or development of a white headed pimple at the base of the hair follicle
• Pus formation with blisters or vesicles [6]
• Crusting lesions with suppuration
• Pain and tenderness felt on the lesion
• Formation of a large swollen bump or mass 
• Erythema formation with inflammation
• Pain and pruritus at the lesion
• Circinate plaque formation with central pustules 
• Hypertrophic scarring 

A complete and detailed clinical history of the lesion will give away the diagnosis of folliculitis to the primary physician. Laboratory tests are not the primary workup procedure, and are ordered only when the history and physical examination doesn't lead easily to diagnosis. When the empiric treatment appears to be unresponsive, swabs of the secretions may be taken for culture and sensitivity to determine the causative agent and its respective sensitivity to antibiotics [7]. Skin biopsy may sometimes be done to rule out other cutaneous disease conditions [8].

In general, the treatment of choice for folliculitis is greatly dependent on the severity of the disease. For mild folliculitis, antibiotic creams (mupirocin) may be used while oral antibiotics (cephalexin) for 7 to 10 days may be given for recurrent cases. For fungal folliculitis, topical antifungals may be used for folliculitis caused by yeasts and fungus like those seen in Pityrosporum folliculitis. For autoimmune or eosinophilic folliculitis, patients may be given steroid creams (betamethasone) and oral corticosteroids for severe inflammation.

Patients presenting with large boils and carbuncles may be surgically incised and drained to reduce the scarring of the skin and other complications. Light and laser therapy are reserved for refractory cases of folliculitis which are not responsive to common treatment modalities [9].

Superficial folliculitis almost always resolves without any intervention or treatment. Severe forms of folliculitis may respond well with treatment but there is a very high recurrence rate. Mortality from primary folliculitis is rare. There is increasing morbidity coupled to severe complications like cellulitis, chronic scarring, furunculosis, abscess formation, carbuncle formation, and permanent hair loss.

Folliculitis is most often caused by the bacterium Staphylococcus aureus. This cutaneous infection could further be classified as either superficial or deep depending on how much hair follicle is involved. The deeper the folliculitis the more severe the disease conditions and the more complicated is its clinical course and treatment. Any break in the integrity of the follicles can predispose it to bacterial, viral or fungal infections. The following everyday conditions are associated with follicular damage:

• Inflammatory skin conditions like acne and dermatitis
• Skin incisions from surgery or scrapings
• Unhygienic coverings of the skin like old plaster dressing and adhesive tapes
• Sweating and heat caused by wearing booties, waders, and rubber gloves
• Friction from shaving and tight clothing

The occurrence of superficial folliculitis is very common all over world. Because most cases resolve spontaneously, only a few cases are brought to the physician for medical care and recording. Patients are found to be more susceptible to folliculitis if they are diabetics, on immunosuppressive drugs, having preexisting dermatoses, on long term antibiotics use, on chronic anti-retroviral therapy [1], and on chronic occlusive dressings. Folliculitis has been frequently observed among military personnel on the site of their anthrax and small pox immunizations [2].

There is no sexual or racial predilection for the common folliculitis. Although, the incidence of pseudofolliculitis or traction folliculitis are more common among Afro-Americans [3], while the Japanese are more prone to the eosinophilic type of folliculitis [4]. Folliculitis may also occur in all age groups.

Superficial folliculitis may occur due to hair follicle occlusion or direct trauma to the follicles. In can also occur as a secondary infection after a primary cutaneous infection spreads contiguously towards the hair follicle. Autoimmune forms of folliculitis or eosinophilic folliculitis are postulated to occur due to the antibodies that attack the sebum and the sebocytes (fat cells) of the body. Theories have been brought to light that the papulopustular eruptions that occur in superficial folliculitis are due to the abnormal epidermal differentiation that leads to follicular obstructions and inflammations [5].

Folliculitis may easily prevented from recurring if the underlying disease is treated and controlled like those with diabetes mellitus and tuberculosis. Patients with recurrent barber’s itch on the mustache area may opt not to shave them and grow beards instead. The use of shaving creams may brace the skin and prevent follicular damage in the process.

Folliculitis occurring in areas of high friction may be avoided by loosening the garment or fabric that causes the perennial friction. Rubber gloves must be thoroughly cleaned and dried in between uses to prevent skin infections. Cleaning of hot tubs with chlorine can help prevent the propagation of the bacteria Pseudomonas aeroginosa that can infect the skin [10].

Folliculitis is a very common skin infection that starts at the hair follicles of the skin. Folliculitis is sometimes referred to as hot tub rash, razor bumps, and barber’s itch. It is caused by various microorganisms. It is usually brought about by bacterial, viral (herpes), or fungal (yeast) infections. The infection may start as a reddish macule or a white headed pustule but can later complicate into a non-healing and crusting lesion. Milder forms of folliculitis will present with a sore and itchiness while severe forms of folliculitis may cause scarring and permanent hair loss in the affected area.

Definition

Folliculitis is clinically defined as an active inflammation of one or more hair follicles found anywhere in the skin.

Cause

Any break in the integrity of the skin, and infected by bacteria, virus, and fungal etiologic agents.

Symptoms

Symptomatology ranges from red painless sore to an exudative blistering abscess.

Diagnosis

A complete clinical history and direct physical examination of the skin, skin swab for culture and sensitivity testing [11] may be used to diagnose the condition.

Treatment and follow-up

Patients are given topical and oral antibiotics and anti-fungal agents. Phototherapy and laser therapy.

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