Folliculitis (a3101)

FOLLICULITIS (folliculitis), inflammation of the hair follicle, ending in most cases with partial melting of the tissue. Clinically, initially a small, not sharply limited redness and barely noticeable swelling occurs around the hair, after which a pustule (pustule) forms in the center; sometimes the matter does not reach the formation of a pustule, only a nodular rash develops, and in such cases the process often proceeds chronically. The pustule opens and the hair often falls out together with the purulent mass. In uncomplicated folliculitis, the hair then grows again, atrophy does not occur. In view of the fact that hair and sebaceous glands biologically form a whole, in many cases it is not possible to conduct a strict anatomical division between inflammation of the sebaceous gland (acne) and folliculitis. Uncomplicated folliculitis is localized only in the superficial layers of the skin. To folliculitis, inflammation of the perifollicular tissue often joins — perifolliculitis, clinically nodular, mostly acute formations develop (see Furuncle). The etiology of folliculitis is various, more often infectious. The causative agents of folliculitis can be staphylococci, plant fungi, pale spirochete, Koch's bacillus, etc. In addition, medicamentous folliculitis is often encountered, both of exogenous and endogenous origin. As a result of irritation of the follicle areas by various chemical substances, professional folliculitis — Folliculitis barbae, or sycosis (see) often occurs. Folliculitis decalvans (syn. pseudoalopecia atrophicans crustosa, acne decalvans) — see Pseudopelade. Folliculitis gonorrhoica, gonorrheal folliculitis — a rare exogenous complication of gonorrhea, first described by Jesionek; more often occurs in men on the prepuce and raphe of the penis, in women — in the area of the perineum. It remains unclear what happens first, the penetration of gonococci into the skin or accidental damage to the latter. Initially, a small superficial red papule or a deeper dense nodule the size of a pea occurs in the follicle area, with inflammatory phenomena around it; subsequently the nodule suppurates and opens, a small funnel-shaped ulcer forms, in the purulent discharge of which gonococci are found in abundance. Histologically: intra- and perifollicular melting, in purulent plugs gonococci are easily detected, on the contrary, in the epithelium and in the surrounding connective tissue this is achieved with difficulty. Treatment — electrocoagulation. Folliculitis et perifolliculitis capitis abscedens et suffodiens Hoffmann (E. Hoffmann) — see Pyoderma. Folliculitis exulcerans serpiginosa nasi Kaposi, syn. acne necroticans exulcerans serpiginosa nasi, serpiginous ulcerating folliculitis of the nose, a rare disease that was previously attributed by some to the group of acne, by others to blastomycosis. According to the research of Finger, this disease should be more correctly referred to as tuberculous skin lesions. At the tip and wings of the nose, small soft pink, rapidly suppurating and merging tubercles occur, forming in the future quite deep serpiginous ulcers with undermined bluish-red edges. After healing, irregular scars remain. Histologically — tuberculous structure. Treatment — as in lupus (see Tuberculous skin diseases). Folliculitis medicamentosa. Medicamentous folliculitis occurs both of exogenous and endogenous origin. Of exogenous ones, mercurial folliculitis, occurring at the places of rubbing of sulfur ointment or other mercury preparation, has the greatest practical significance. Folliculitis also often occurs from tar, pyrogallic, chrysarobin, and other ointments. Sometimes the cause of folliculitis is insufficiently purified vaseline from kerosene residues. In the event of folliculitis occurring, the use of the ointment causing it should be stopped immediately. Folliculitis is especially predisposed in hairy subjects, which should be taken into account when prescribing ointment therapy. To endogenous medicamentous folliculitis belong mainly iodine and bromine folliculitis, relatively often occurring on the skin of the face, trunk and limbs upon internal intake of iodine and bromine alkalis; sometimes other phenomena of iodism are also noted simultaneously. In the occurrence of folliculitis, the intake of the given iodine or bromine preparation should be stopped, and it is possible to test the tolerance of other preparations. Treatment: powders (Zinci oxydati, Talci veneti aa 10.0), shaken mixtures and pastes. Folliculitis professionalis occurs upon prolonged exposure of the skin to chemical substances irritating the follicles; more often localized on the back of the hands and on the flexural surface of the forearms; the appearance of these folliculitis on closed areas of the skin is sometimes conditioned by wearing clothing soaked in oils or kerosene. Folliculitis can occur when working with petroleum residues, lubricating oils, kerosene, coal 'pitch', paraffin, chlorine compounds, etc. Professional folliculitis is more often encountered among turners, fitters, motor mechanics, drivers, oil workers, tractor drivers, locomotive engineers, etc. Skin changes occurring from lubricating oils, petroleum residues, paraffin, etc., receiving the names of kerosene or paraffin mange, resinous skin, etc., consist in hyperpigmentation, hyperkeratosis and inflammatory changes. As a result of chronic inflammation of the follicle areas, so-called oil folliculitis, or acne, occur. The latter clinically sometimes resemble the tuberculinoid pustulonecrotic tuberculinid, differing from it by the presence of obvious pustulization in individual rashes, as well as numerous comedo-like black plugs in the follicular openings; in addition, the anamnesis helps, as well as the disappearance of rashes after stopping work with substances irritating the follicles. — Prevention of professional folliculitis consists in careful observance of skin hygiene: appropriate special clothing, not to work with rolled-up sleeves, energetic washing of hands after work with warm water and soap, general shower, etc.; no less significance has the rationalization and mechanization of production processes, in which the worker would have minimal direct contact with irritating and follicle-clogging substances. Treatment: warm baths, shaken mixtures with the addition of keratolytic agents (e.g. Ac. salicylici 1.5, Flor. sulfur. 5.0, Spiritus saponato-kalini ad 100.0). In severe cases, change of profession and general strengthening treatment; in case of complication with deep pyoderma, treatment as for the latter. Hydradenitis suppurativa, syn. tuberculous abscesses of the axillary fossae, 'horse sweat', a pyodermic disease — staphylococcal infection of apocrine (large sweat) glands. Starting as dense subcutaneous nodes, hydradenitis then undergoes softening, the skin turns red and thins, abscesses open, releasing abundant thick pus. Unlike the ordinary furuncle, there is no core here, the shape of the abscess is spherical, the process proceeds more slowly; on average each abscess exists about 10 days. Sometimes individual nodes do not suppurate and, existing in such a form often 7–15 days, dissolve spontaneously. The abundance of hair and intense sweating in the axillary fossae create good soil for pyogenic infection: hydradenitis often recurs and is often complicated by ordinary pyoderma. Hydradenitis is often found in obese and weakened subjects, as well as in persons not observing skin hygiene. Prevention: observance of cleanliness in the axillary fossae, treatment of hyperhidrosis. Treatment in principle does not differ from that in furuncles; special attention should be paid to disinfection and dry maintenance of the skin of the axillary fossae; for the first, it is sufficient to wipe the surrounding healthy skin twice a day with camphor or some other alcohol; further the hair should be cut (not shaved). Nodes that should not be surgically opened are covered with clean ichthylol, dry heat on top. Ultraviolet light can be applied, as well as X-rays. Good action is exerted by protein therapy. In severe cases — general strengthening treatment. Folliculitis rubra Wilson — see Keratoses. Folliculitis salerotisans nuchae — see Acne, keloid. Folliculitis ulerythematosa reticulata Mac Kee, Parounagian — see Ulerythema. Folliculitis varioliformis, s. necroticans — see Acne, necrotica.