Scalp inflammation is scientifically called folliculitis. This disease can occur under the influence of various factors: infections, viruses, fungi, etc. The inflammation of the follicle should in no way be left unattended, since this disease can be accompanied by serious complications. So, today we will talk about the manifestations of folliculitis, methods of its prevention and treatment methods.
What is folliculitis
Folliculitis – Infectious lesion of the middle and deep sections of the hair follicle, leading to its purulent inflammation. Folliculitis can have a bacterial, fungal, viral, parasitic etiology. It is manifested by the appearance in the places of hair growth of single or multiple pustules, in the center of which the hair passes. Opened pustules form ulcers, their healing with a deep lesion of the hair follicle is accompanied by scarring. Diagnosis of folliculitis is carried out by dermatoscopy, smear microscopy and examination of detachable pustules. The treatment is carried out with aniline dye solutions, antiseptic agents, local and systemic use of etiotropic drugs: antibiotics, antimycotics, acyclovir.
Along with hydradenitis, sycosis, streptoderma and streptococcal impetigo folliculitis refers to purulent skin diseases (pyoderma), whose prevalence among the population reaches 40%.
In hot countries, the incidence of folliculitis is higher because the climate itself contributes to the development of infection. A high level of morbidity is also noted among socially disadvantaged segments of the population living in unsanitary conditions.
In some cases, folliculitis begins with ostiofollikulit – superficial inflammation of the hair follicle, exciting only his mouth. Further spread of the infection to the depth of the follicle leads to the transformation of the ostiofolliculitis into the folliculitis.
Causes of folliculitis
Infectious agents that cause folliculitis, in most cases, are bacteria, mainly staphylococcus. There are folliculitis due to pseudomonads, the causative agent of syphilis, gonorrhea and other bacteria. The cause of the disease can be fungal infections of the skin (fungi of the genus Candida and Pityrosporum, dermatophytes), viruses (molluscum contagiosum, simple and herpes zoster) and parasites (for example, tick causing demodicosis). In accordance with the etiology of the infectious process, clinical dermatology produces bacterial, fungal, viral, syphilitic and parasitic folliculitis.
The penetration of the infection inside the hair follicle occurs through minor skin damage: scratches, excoriation, abrasions, soak. The probability of infection is increased in people suffering from pruritic dermatoses (eczema, pruritus, atopic dermatitis, allergic contact dermatitis, Dühring dermatitis) and therefore constantly combing their skin, as well as in persons suffering from excessive sweating.
The weakening of the body’s defenses and skin barrier function facilitates the penetration of the infection inside the hair follicle and the development of folliculitis. Therefore, factors contributing to infection include diabetes mellitus and various immunodeficiencies: HIV infection, conditions associated with prolonged illness or immunosuppressive therapy. Prolonged percutaneous use of glucocorticosteroids leads to a decrease in local immunity and may also favor the development of folliculitis. Reducing the protective properties of the skin occurs with prolonged exposure to various chemicals: kerosene, lubricants, technical oils. The occurrence of a professional folliculitis in mechanics, tractor drivers, and oilmen is connected with these.
Epidemiology. Statistical data
Folliculitis is most common in hot countries where the climate favors the development of inflammatory skin diseases. Also, this disease is more common in socially disadvantaged strata of society, which is facilitated by unsanitary conditions of life.
Accurate statistics are not provided, since in most cases such patients rarely seek medical help, preferring to self-medicate. In the field of view of physicians most often fall into patients who have developed complications on the background of folliculitis: phlegmon, abscess or lymphadenitis.
Folliculitis begins with redness and infiltration in the area of the hair follicle. Then a conical pustule penetrated with downy hair is formed with purulent contents in the center. After its opening and release from pus, a small sore is formed, covered with a bloody-purulent crust. If the entire follicle is affected, hyperpigmentation or a scar remains on the skin after the skin is peeled. More superficial folliculitis may resolve, leaving no trace behind. The process of development and resolution of inflammation of one follicle takes up to 1 week.
Most often the folliculitis is multiple in nature. Its elements are usually located on the hairy areas of the skin: on the face, head, in the armpits, in the groin, on the legs (mainly in women depilating the legs and thighs). The rash is accompanied by pain and itching of varying severity. In the absence of correct treatment and hygienic measures, folliculitis is complicated by the development of boils, carbuncles, hydradenitis, abscesses, phlegmon.
Staphylococcal folliculitis usually localized in areas of bristly hair growth, most often it is the chin and skin around the mouth. It occurs mainly in men who shave their beards and mustaches. May be complicated by the development of sycosis.
Pseudomonas folliculitis It is popularly called “hot folliculitis”, because in most cases it occurs after taking a hot bath with insufficient chlorination of water. Often develops in patients undergoing antibiotic treatment for acne. It is clinically expressed in a sharp increase in acne, the appearance of pustules penetrated by hair on the face and upper part of the body.
Syphilitic folliculitis (acne syphilis) develops in secondary syphilis, accompanied by non-scar alopecia in the growth zone of the beard and mustache, as well as the scalp.
Gonorrheal folliculitis is a complication of untreated and long-lasting gonorrhea. Favorite localization – the skin of the perineum in women and the foreskin in men.
Candida folliculitis observed mainly with occlusive dressings, in bedridden patients and with prolonged fever.
Dermatophytic folliculitis characterized by the onset of inflammatory changes from the superficial horny layer of the epidermis. The process then gradually captures the follicle and hair shaft. May occur on the background of trichophytia and favus, leaving cicatricial changes.
Herpetic folliculitis characterized by the formation of vesicles in the mouths of the hair follicles. Observed on the skin of the chin and nasolabial triangle, often in men.
Folliculitis, caused by demodicosis, is manifested by reddening of the skin with the formation of characteristic pustules in the mouths of hair follicles, around which a scaly peeling is noted.
Impetigo Bockhart – Another version of folliculitis. It develops with skin maceration. Most often occurs with hyperhidrosis or as a result of therapy with warming compresses.
Diagnosis of folliculitis
Diagnostic measures for suspected folliculitis are aimed at studying the condition of the hair follicle; identification of the causative agent that caused the inflammation; exclusion of a specific etiology of the disease (syphilis, gonorrhea); identification of associated diseases conducive to the development of an infectious process.
At a consultation with a dermatologist, an eruption and dermatoscopy examination is conducted, which helps the doctor determine the depth of the lesion of the follicle. Produced fence detachable pustules for microscopy and bacteriological seeding, research on fungi and pale treponema. To exclude gonorrhea and syphilis, PCR diagnostics and RPR testing are performed. If necessary, the patient is assigned an immunogram, a blood test for sugar and other examinations.
In the course of diagnosis, folliculitis is differentiated from ostiofolliculitis, frioderma, Hoffmann perifolliculitis, furunculosis, nodular cystic acne, streptococcal impetigo, pink lichen from Gibert, and drug-induced toxicoderma.
Complications of folliculitis
In most cases, folliculitis is easy and does not represent a real threat to human life. In some cases, may develop complications. As a rule, complications develop in the absence of adequate treatment, non-compliance with the rules of personal hygiene and with insufficient immune response of the body.
Complications of folliculitis include:
- Furuncle (and in turn it can lead to the development of lymphadenitis and hydradenitis);
- Dermatophytosis of the scalp (with folliculitis caused by dermatophytes);
- Follicular scar formation.
- In isolated cases, such severe complications in the background of folliculitis as nephritis, meningitis and severe forms of pneumonia are described.
Folliculitis therapy should be consistent with its etiology. With bacterial genesis of folliculitis, ointments with antibiotics are prescribed, with fungal – antifungal drugs, treatment of herpes folliculitis is carried out with acyclovir.
At the beginning of the disease, local treatment and treatment of lesions with solutions of aniline dyes (fukartsin, brilliant green, methylene blue) are sufficient. To prevent the spread of infection to healthy areas of the skin, they are treated with salicylic or boric alcohol. Additionally applied UFO.
Cases of severe recurrent folliculitis require systemic therapy. For staphylococcal folliculitis, cephalexin, dicloxacillin, erythromycin are prescribed inside. Treatment of severe forms of pseudomonad folliculitis is performed with ciprofloxacin. In case of candidal folliculitis, fluconazole and itraconazole are used, and in dermatophytic folks, terbinafine is used. At the same time, they conduct therapy for concomitant diabetes mellitus or immunodeficiency states.
How to treat inflammation of the hair follicle
At the initial stage of the disease, treatment of pustules with suitable means is sufficient. Camphor (2%) and salicylic alcohol (1-2%), solution of brilliant green (2%) or methylene blue, fucorcin are suitable for this. Now gels, creams and lotions of the series Klerasil are very popular. If the disease affects the deeper layers of the skin and is accompanied by significant purulent accumulations, it is necessary to open the bubbles, remove their contents, and then treat with one of the listed agents. It is recommended to apply ichthyol compresses twice a day.
If the disease has become chronic and relapses, serious medical therapy is required. In this case, antibiotics and sulfonamide drugs are prescribed. Immunostimulating therapy is also indicated.
When inflammation of the hair follicles is observed on the arms, legs, torso, it is impossible to squeeze the affected parts of the body and squeeze the bubbles, as this increases the risk of developing boils and even cellulitis. Well-proven investment by ultraviolet rays. The general course is 6-10 procedures. Sessions are prescribed every day or every other day. If folliculitis has occurred on the background of diabetes mellitus, a corrective diet is prescribed to normalize carbohydrate metabolism and reduce the risk of disease recurrence. Treatment of staphylococcal folliculitis involves the use of ointment Muportsin or similar, an internal technique of cefalexin, dicloxacillin, erythromycin or methicillin.
In severe cases of pseudomonadonic lesions, ciprofloxacin is prescribed. If the causative agent is gram-negative bacteria, local therapy with benzoyl peroxide is necessary. In case of fungal infection, appropriate means are necessary, for internal use – terbinafine, fluconazole, intracanosol. Herpetic folliculitis should be treated with acyclovir.
Inflammation of the hair follicle in most cases has a favorable prognosis. In severe cases and damage to the deeper layers of the skin, pigmentation may remain after removal of the peel. Complications of folliculitis are rare and also successfully treated with modern methods.
Alternative treatment: use of medication
Depending on the cause of the inflammation, additional measures may be recommended. If folliculitis is caused by prolonged use of hormonal drugs, then they are simply canceled. Of course, this takes into account the benefits and possible risks to the patient. In addition, doctors prescribe antibacterial agents that affect the microorganism. However, before that it is necessary to pass an analysis to identify sensitivity to certain drugs. Often, doctors use the following medications: Metronidazole, Naxojin, Cefotaxime, and so on. Remember that without prior analysis, treatment may not be effective.
Ways to prevent disease
Is there any method that avoids inflammation of the hair follicle? Of course, yes. For a start, you should review your own lifestyle and observe basic hygiene.
- Regularly cleanse your body with gels and special scrubs.
- Take a shower at least once a day.
- Try not to use other people’s towels, handkerchiefs and clothing.
- Avoid dubious ponds, saunas and swimming pools.
- If you are swimming, the water in an enclosed space should be chlorinated. At the same time its pH should be at least 8.
- Avoid wearing heavy underwear.
- Avoid severe friction of clothing in the area of skin folds, for example, in the groin area.
- When depilating and shaving, always use emollients. After the procedure, apply to the skin alcohol softening lotions. They will help to disinfect the integument and prevent bacteria from entering the wound.
It is possible to earn inflammation of the hair follicles even when testing probes in cosmetics stores. For example, mascara, which someone tested before you, can be a source of infection of the ciliary follicles. It is harder and harder to treat them, so do not put yourself at such a risk (find out here how to wake dormant hair follicles).