Folliculitis refers to the inflammation of a hair follicle that results in the formation of papules or pustules, commonly known as 'pimples'

Aetiology

• Folliculitis can be caused by various factors, predominantly bacterial infections, specifically Staphylococcus aureus
• It can also result from Gram-negative organisms, often following long-term antibiotic therapy for conditions like acne
• A particular form, eosinophilic folliculitis, is sterile and most commonly arises in the context of immunosuppression, like in HIV patients
  • The causative factor in this case is not an infection but a reactive condition associated with the immune status

Clinical features

• The most characteristic clinical features of folliculitis are the presence of papules and pustules
• These can appear anywhere on the body except for the palms of the hands and soles of the feet

Investigations

• In most cases, the diagnosis of folliculitis is clinical, based on the presence of characteristic signs and symptoms
• However, in the case of eosinophilic folliculitis, a skin biopsy is required, revealing eosinophils in the skin surface

Management

• Application of topical antibiotics, with a suggested addition of antibacterial soaps (e.g. chlorhexidine-containing solutions like Hibiscrub)
• Oral antibiotics may also be required in more severe cases or cases that don't respond to topical treatments
• Special variants, such as Gram-negative folliculitis following prolonged antibiotic therapy for acne, or hot tub folliculitis (caused by Pseudomonas), may necessitate a different approach, tailored to the specific situation