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PubMed1991

Pityrosporum folliculitis in the Philippines: diagnosis, prevalence, and management.

Sixty-eight typical cases were studied to define the course of Pityrosporum folliculitis in a tropical setting. Contrary to reports in the literature, we found Pityrosporum folliculitis to be polymorphic. The "molluscoid" comedopapule was the most characteristic and common lesion, and it yielded consistently high spore counts. The face was commonly involved. To establish the diagnosis, we used direct microscopy of potassium hydroxide/Parker blue-black ink mounts of the lower poles of comedonal plugs. Pityrosporum folliculitis is common in the Philippines, although our adult controls had a low incidence of skin carriage of Pityrosporum orbiculare on the face compared with those reported in the West. Pityrosporum folliculitis coexisted with acne vulgaris in 56% of patients, and the addition of antimycotics to the acne regimen produced dramatic clearing of lesions.

Acne Vulgaris↗
PubMed1986

Pustular folliculitis associated with Demodex folliculorum.

A 49-year-old man presented with an acute onset of folliculitis on his right cheek. The folliculitis was unresponsive to antibiotics. A potassium hydroxide preparation of a scraping from the affected area revealed the presence of numerous Demodex mites. The patient was treated with topical crotamiton (Eurax) cream resulting in rapid resolution of the folliculitis. We believe that this case represents a localized pustular folliculitis resulting from a heavy infestation with Demodex folliculorum. In spite of more than 50 years of investigation, the role of D. folliculorum in human cutaneous disease remains controversial.

Folliculitis↗
PubMed2002

Cutaneous larva migrans with folliculitis: report of seven cases and review of the literature.

Seven patients (four men, three women, mean age 31 years), all returning from the tropics, presented with pruritic folliculitis and creeping eruption. The folliculitis consisted of 20-100 follicular papules and pustules confined to a particular area of the body, mainly the buttocks. The creeping eruption consisted of two to 10 serpiginous or linear burrows 1-5 cm long located either in the same area or in a different area from the folliculitis. Five patients were cured with one to three courses of ivermectin (one course in two cases, two courses in two cases and three courses in one case) and two patients were cured with a 3-day regimen of albendazole. Folliculitis should be added to the dermatological manifestations of cutaneous larva migrans. Treatment is more difficult than in classical forms of cutaneous larva migrans.

Adult↗
PubMed1999

Itchy folliculitis and human immunodeficiency virus infection: clinicopathological and immunological features, pathogenesis and treatment.

The predominant itchy folliculitis associated with human immunodeficiency virus (HIV) infection appears to be an eosinophilic folliculitis (EF). This is characterized by lytic degeneration of sebaceous glands and an inflammatory infiltrate in which eosinophils and CD8+ T lymphocytes predominate. All patients have low CD4 counts and present late on in their HIV disease. Lesional distribution is mainly truncal, with a significant proportion also having facial involvement. Our prospective survey has shown that it is impossible to differentiate clinically between infective folliculitis and EF, and we recommend therefore that all cases are biopsied. We review the clinicopathological and immunological aspects of HIV-associated itchy folliculitis, in particular HIV-associated EF as well as current theories on pathogenesis and treatment. We suggest that HIV-associated EF is an autoimmune disease with the sebocyte or some constituent of sebum acting as the autoantigen.

AIDS-Related Opportunistic Infections↗
PubMed2000

Simultaneous occurrence of folliculitis decalvans capillitii in identical twins.

Folliculitis decalvans is a chronic purulent folliculitis resulting in permanent hair loss and follicular atrophy. We report 32-year-old identical female twins presenting with relapsing pruritic outbreaks on the scalp resulting in areas of permanent baldness. Staphylococcus aureus was detected in the lesions of both women. Histopathology confirmed the diagnosis of folliculitis decalvans. Immunological testing showed no alteration of the immune system. To our knowledge, this is the first report on folliculitis decalvans occurring in identical twins, suggesting a possible genetic component in this disease.

Adult↗
PubMed1998

Steroid acne vs. Pityrosporum folliculitis: the incidence of Pityrosporum ovale and the effect of antifungal drugs in steroid acne.

BACKGROUND: Steroid acne is a folliculitis that can result from systemic or topical administration of steroid, and has been described as showing a similar clinical picture to Pityrosporum folliculitis, but there have been few reports about the incidence of Pityrosporum ovale and the effect of antimycotic drugs in steroid acne and other acneiform eruptions. Our purpose was to describe the association between steroid acne and P. ovale, and to confirm the superior efficacy of oral antifungal drugs over anti-acne drugs in the treatment of steroid acne. METHODS: The history, clinical features direct microscopy, histopathologic analysis, and therapeutic results of 125 cases with steroid acne or other acneiform eruptions were described and compared. RESULTS: Over 80% of patients with acneiform eruption receiving systemic steroid revealed significant numbers of P. ovale in the lesional follicle. Furthermore, oral antifungal drug (itraconazole) showed significantly better clinical and mycologic effects than any other group of medications used in this study. CONCLUSIONS: Steroid acne and other acneiform eruptions showing discrete follicular papules and/or pustules localized to the upper trunk and acneiform facial skin lesions associated with multiple acneiform lesions on the body in the summer period should be suspected as Pityrosporum folliculitis. In addition, oral antifungal drugs recommended for Pityrosporum folliculitis; however, it will require a larger case-control study to confirm the superiority of antifungal therapy over anti-acne treatment.

Acne Vulgaris↗
PubMed1999

An epidemic outbreak of Malassezia folliculitis in three adult patients in an intensive care unit: a previously unrecognized nosocomial infection.

BACKGROUND: Malassezia is a lipophilic fungus commonly found in normal human skin. Infection of the hair follicle by Malassezia furfur occurs in patients with predisposing factors such as diabetes or immunosuppression, or who are undergoing antibiotic treatment. Malassezia furfur folliculitis is an infrequent nosocomial infection which may be associated with fomite transmission. METHODS: We reviewed the clinical files of three adult patients from an intensive care unit (ICU) who simultaneously developed folliculitis through Malassezia infection. We specifically analysed predisposing factors, possible transmission modes, characteristics of skin lesions, results of biopsies and cultures, treatment, and patient outcome. RESULTS: The three male patients were in neighboring beds and they all had factors that predisposed them to underlying immunosupression. Simultaneously, and within hours of each other, they developed erythematous follicular papules and pustules on the face and chest. The skin biopsies revealed an acute folliculitis with abundant round to oval yeasts of up to 5 microm in diameter. Stains for fungi (Schiff's peryodic acid, Grocott and silver methenamine) revealed numerous unipolar budding yeasts without hyphae, consistent with M. furfur. Conventional cultures were negative. The diagnosis of folliculitis by M. furfur was established and antifinigal treatment initiated, with adequate outcome of the dermatosis. After this outbreak, the aseptic and hygienic measures of the health care personnel of the ICU were reviewed and corrected. CONCLUSIONS: The simultaneous emergence of this superficial infection by M. furfur suggests fomite participation. This dermatomycosis is an infrequent nosocomial infection in adults, which to our knowledge has not been previously reported.

Adult↗
PubMed2003

Actinic superficial folliculitis.

Actinic superficial folliculitis was first described in 1985, and since then only three reports have been published. Clinically and histopathologically this disease is very particular and has been suggested to be considered as an entity. We report on a 30-year-old man who presented with an extensive superficial follicular pustulosis on his back, shoulders and upper chest after exposure to intense heat and subsequent sweating on a sunny day. The pustules arose within 24-36 h afterwards. Histology and immunohistochemistry revealed subcorneal pustules, suppurative folliculitis and an infiltrate consisting of T cells, macrophages and neutrophils around the hair follicle, sebaceous glands and small vessels. To the best of our knowledge this is the fourth report on actinic superficial folliculitis and the first on which a characterization of the inflammatory infiltrate has been performed. Because of the impressive, unique symptoms and the characteristic histology we agree with those who have suggested that actinic superficial folliculitis is a new entity.

Acne Vulgaris↗
PubMed1995

Eosinophilic folliculitis. The histologic spectrum.

We sought to define the light microscopic features of eosinophilic folliculitis as it occurs in human immunodeficiency virus (HIV)-infected individuals. The histologic findings of 52 biopsies from 50 patients were graded and compared with six biopsies of suppurative folliculitis from HIV-infected individuals. In all patients, clinical examination showed an eruption of pruritic follicular papules, and the folliculocentric nature of the disorder was confirmed histologically. Perifollicular infiltrates of lymphocytes and eosinophils were identified in all study biopsies, and there was also spongiosis of follicular epithelium. The inflammatory reaction was focused at the level of the follicular isthmus and the sebaceous duct. In all biopsies, lymphocytes and/or eosinophils were present within spongiotic follicular epithelium, but intrafollicular neutrophils were rare. Sebaceous glandular inflammation, eosinophilic pustule formation, and follicular rupture were present in less than half of the biopsies. Small numbers of microbes (bacteria, yeast, Demodex) were identified in 25% of the study biopsies in routine or special stains, but the organisms were away from areas of inflammation and were interpreted as nonpathogenic flora. The biopsies of suppurative folliculitis differed in that neutrophils and macrophages predominated in the infiltrate, microorganisms were readily identified in the inflammatory reaction, and the involved follicle was often ruptured. We believe that eosinophilic folliculitis is a unique HIV-associated dermatosis distinguishable from other folliculitides and papular dermatitides by clinical examination and light microscopy. We present our diagnostic approach.

Adult↗
PubMed2004

Involvement of granulysin-producing T cells in the development of superficial microbial folliculitis.

BACKGROUND: Granulysin is a recently identified antimicrobial protein expressed on cytotoxic T cells, natural killer (NK) cells and NKT cells. It has been shown that granulysin contributes to the defence mechanisms against mycobacterial infection. Superficial microbial folliculitis is a common skin disease. In a previous report, we showed that, as a first line of defence, alpha-defensin, a human neutrophil peptide, and beta-defensin (human beta-defensin-2) were expressed in infiltrating neutrophils and in lesional epidermal keratinocytes, respectively, in superficial folliculitis. As we also observed many infiltrating lymphocytes in lesional dermis, we hypothesized that infiltrating lymphocytes may possess antimicrobial substances, such as granulysin, and play a role in the defence mechanism as a second line of defence. OBJECTIVES: Seven specimens of superficial microbial folliculitis diagnosed clinically and histologically were examined by means of immunohistochemistry. To identify the phenotype of cells expressing granulysin, confocal laser microscopic examination was performed. RESULTS: A dense lymphoid cell infiltrate was observed in pustules, in the perivascular regions. A large number of these lymphoid cells were positive for granulysin. Phenotypically, cells consisted of CD3+ T cells, CD8+ T cells and UCHL-1+ T cells. CD20+ cells and CD56+ cells were not observed. Microscopic examination with a confocal laser showed that the lymphocytes producing granulysin were CD3+ and CD4+ T cells but not CD8+ T cells. CONCLUSIONS: We showed that many granulysin-bearing T cells infiltrated affected follicles and perilesional dermis in superficial microbial folliculitis. However, few granulysin-positive lymphoid cells were observed in sterile pustular lesions. Our observations indicated that adaptive immunity such as granulysin, a lymphocyte-produced antimicrobial protein, may play an important role in the cutaneous defence mechanism.

Adult↗
PubMed1986

Whirlpool-associated folliculitis caused by Pseudomonas aeruginosa: report of an outbreak and review.

An outbreak of folliculitis caused by Pseudomonas aeruginosa serotype O:7 occurred among the guests of a hotel in St. John's, Newfoundland, Canada, and the source of the infection was traced to the hotel whirlpool. Of 36 persons who used the whirlpool, 26 (72%) developed folliculitis within 1 to 5 days after exposure; the attack rate was significantly higher for children (90%) than for adults (50%). The rash characteristics were consistent with those of Pseudomonas folliculitis previously described (T. L. Gustafson, J. D. Band, R. H. Hutcheson, Jr., and W. Schaffner, Rev. Infect. Dis. 5:1-8, 1983). This is considered to be the first outbreak in which P. aeruginosa serotype O:7 has been incriminated. Published reports to date of outbreaks of Pseudomonas folliculitis associated with the use of whirlpools, hot tubs, swimming pools, etc., were reviewed.

Adolescent↗
PubMed2003

Treatment of gram-negative folliculitis in patients with acne.

Gram-negative folliculitis may be the result of long-term antibacterial treatment in acne patients. It is caused by bacterial interference and replacement of the Gram-positive flora of the facial skin and the mucous membranes of the nose and infestation with Gram-negative bacteria. These Gram-negative bacteria include Escherischia coli, Pseudomonas aeruginosa, Serratia marescens, Klebsiella and Proteus mirabilis. The occurrence of Gram-negative folliculitis should be considered in acne patients in whom oral treatment with tetracyclines has not resulted in a significant improvement of acne lesions after 3-6 months' treatment. The occurrence of Gram-negative folliculitis in acne patients is believed to be generally underestimated, since correct sampling and bacteriology is rarely performed by clinicians. Gram-negative folliculitis in acne and rosacea patients is best treated with isotretinoin (0.5-1 mg/kg daily for 4-5 months).

Dermatologic Agents↗
PubMed2004

Folliculitis: recognition and management.

Folliculitis is an inflammatory reaction in the superficial aspect of the hair follicle and can involve the follicular opening or the perifollicular hair follicles. The pilosebaceous unit of the follicle is divided into three compartments: the infundibulum (superficial part, outlined by the sebaceous duct), the isthmus (between the sebaceous duct and arrector pili protuberance), and the inferior segment (stem and hair bulb). This anatomical scheme forms the basis for any evaluation of the clinical manifestations of folliculitis. Most of the follicular conditions can be classified according to their anatomical location and histopathologic patterns. Clinically, the inflammation manifests as 1mm-wide vesicles, pustules, or papulopustules in acute cases; however, hyperkeratosis and keratotic plug formations are indicative of a chronic process. The presence of superficial pustules does not always imply an infectious origin, as there are many noninfectious types of folliculitis. In this review, we describe the different types of folliculitis based on their etiology, clinical manifestation, and treatment. We also discuss some newly described disorders and the latest information on their treatment.

Acute Disease↗
PubMed2005

Folliculitis after smallpox vaccination: a report of two cases.

Rashes are frequent and potentially serious adverse consequences of smallpox vaccination. Life-threatening rashes must be differentiated from benign, self-limiting ones. Generalized vaccinia, erythema multiforme, and folliculitis are distinct self-limiting entities but may be difficult to differentiate from one another. Two cases of folliculitis after smallpox vaccination are described. Both patients received anthrax vaccination within 2 weeks before smallpox vaccination. Both presented with a papulopustular rash 9 days after smallpox vaccination. Although the rashes were initially diagnosed as erythema multiforme, the clinical features were more consistent with folliculitis. Self-limiting rashes after smallpox vaccination are common and may be difficult to distinguish from each other. These rashes are clinically distinct, with characteristic features. Improvement in diagnosis may help classify the frequency and risk of rashes after smallpox vaccination. The association of vaccine-associated folliculitis, anthrax vaccine, and other potential antigenic triggers should be further explored.

Adult↗
PubMed1986

Nosocomial outbreak of Pseudomonas aeruginosa folliculitis associated with a physiotherapy pool.

Outbreaks of community-acquired Pseudomonas aeruginosa folliculitis have recently been described in association with health spa whirlpools. In February 1984 we detected an outbreak of Pseudomonas folliculitis among hospital staff and patients using a swimming pool in a newly constructed physiotherapy unit. A rash developed in 5 (45%) of the 11 physiotherapists who had used the pool, as compared with 0 of the 17 who had not (p less than 0 005). Pseudomonas folliculitis also developed in 6 (21%) of 29 outpatients and 4 (33%) of 12 inpatients who had used the facility; Pseudomonas infection of a surgical wound also developed in 1 of the 4 inpatients. The epidemic curve was consistent with a continuing common-source outbreak. P. aeruginosa, serotype O:10, was isolated from three physiotherapists, the patient with an infected surgical wound and the pool. A case-control study of pool users did not identify risk factors for infection, although the physiotherapists had spent longer in the pool than had the patients. After hyperchlorination and structural repairs to the pool, no further cases were identified among pool users. This outbreak is the first reported nosocomial outbreak of Pseudomonas folliculitis. Further investigation is needed to determine the risk of serious Pseudomonas infections in hospitalized patients using physiotherapy pools.

Adult↗
PubMed1995

Isotretinoin treatment of human immunodeficiency virus-associated eosinophilic folliculitis. Results of an open, pilot trial.

BACKGROUND: Human immunodeficiency virus-associated eosinophilic folliculitis is a pruritic eruption seen in advanced infection with human immunodeficiency virus. The associated pruritus causes considerable morbidity and is poorly responsive to conventional therapy. We studied whether isotretinoin would prove efficacious in the treatment of human immunodeficiency virus-associated eosinophilic folliculitis. Seven patients with biopsy specimen-proved human immunodeficiency virus-associated eosinophilic folliculitis were treated with a mean of 7.7 weeks of isotretinoin therapy and their responses were monitored. OBSERVATIONS: All patients responded with complete symptomatologic and clinical remission within 1 to 4 weeks of isotretinoin therapy. Four (57%) of seven patients remained in complete remission after just one course of isotretinoin therapy, while three (43%) of seven patients experienced up to three brief relapses, all rapidly responsive to further isotretinoin therapy. Patients remained free of disease for up to 9 months after therapy. CONCLUSIONS: Isotretinoin appears to be a promising treatment for human immunodeficiency virus-associated eosinophilic folliculitis. A double-blind, placebo-controlled trial is indicated.

Adult↗
PubMed1993

Eosinophilic pustular folliculitis (Ofuji's disease). Immunohistochemical analysis.

BACKGROUND: Eosinophilic pustular folliculitis is a distinctive dermatosis that was first described in Japan. Although the histopathologic feature of eosinophilic pustular folliculitis is characterized by follicular infiltrates with numerous eosinophils, its pathophysiology remains unclear. The lesional skin of five patients with eosinophilic pustular folliculitis was examined using several monoclonal antibodies including a variety of anti-leukocyte adhesion molecules: endothelial cell adhesion molecule 1, vascular cell adhesion molecule 1, and intercellular adhesion molecule 1, by means of immunohistochemical techniques. OBSERVATION: Intercellular adhesion molecule 1 expression by keratinocytes was observed on follicular epithelium, but not on epidermis. The migration of eosinophils and lymphocytes, which were intensely positive for antilymphocyte function-associated antigen 1, was limited to follicular epithelium. Endothelial cell adhesion molecule 1 and vascular cell adhesion molecule 1 expression of vascular endothelium was more often observed around hair follicles. There was no reactivity for interleukin 8 in follicular epithelium. CONCLUSIONS: These findings may explain the selective migration of eosinophils and lymphocytes to the hair follicles in eosinophilic pustular folliculitis.

Adult↗
PubMed1994

[Tufted folliculitis of the scalp].

INTRODUCTION: Tufted hair folliculitis is a localized scarring bacterial folliculitis due to Staphylococcus aureus. We present two cases. OBSERVATIONS: Both patients were in their thirties. The first had had an inflammatory sclerous lesion of the vertex for three years, and the second an alopecial scarring lesion. Clinically there were tufts of hair within or around the lesions. Staphylococcus aureus was found in biopsy samples which showed hairs or composed follicles. Prolonged treatment with oral antibiotics led to progressive limitation of the lesions. DISCUSSION: Tufted hair folliculitis is a characteristic folliculitis of the scalp showing scar formation and the presence of Staphylococcus aureus. The review of the literature raises the question of the role of local immunity and the nature of the hair tufts: primary anomaly or secondary to Staphylococcus infection? The therapeutic attitude is not well defined but prolonged treatment with oral antibiotics can stabilize the lesions.

Adult↗