Highlights & Basics
- Causes of folliculitis include bacterial, fungal, viral, and parasitic microorganisms.
- Most commonly superficial and resulting from infection by Staphylococcus aureus; use of antibacterial soaps may suffice as treatment for uncomplicated folliculitis, which is self-limited.
- Deeper infection and inflammation of hair follicles from Staphylococcus aureus generally require systemic antibiotic therapy based on culture sensitivities.
- Other common infectious agents include gram-negative organisms, fungi, viruses, and parasites.
- Folliculitis can occur in patients with acne undergoing long-term oral antibiotic therapy and may mimic an acne flare.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Hot tub folliculitis due to P aeruginosa
Superficial folliculitis of chin due to S aureus
Superficial folliculitis with prominent erythematous papules and pustules
Folliculitis of the scalp
Bacterial folliculitis of chin due to S aureus
Fungal folliculitis: a kerion
Pityrosporum folliculitis
Granulomatous rosacea
Granulomatous rosacea
Citations
Lucky AW, Esterly NB, Heskel N, et al. Eosinophilic pustular folliculitis in infancy. Pediatric Dermatol. 1984 Jan;1(3):202-6.[Abstract]
Buckley DA, Munn SE, Higgins EM. Neonatal eosinophilic pustular folliculitis. Clinical Exp Dermatol. 2001 May;26(3):251-5.[Abstract]
Faergemann J. Pityrosporum infections. J Am Acad Dermatol. 1994 Sep;31(3 Pt 2):S18-20.[Abstract]
Ota T, Hata A, Tanikawa A, et al. Eosinophilic pustular folliculitis (Ofuji's disease): indomethacin as a first choice of treatment. Clin Exp Dermatol. 2001 Mar;26(2):179-81.[Abstract]
Oranje AP, Folkers E. The Tzanck smear: old, but still of inestimable value. Pediatr Dermatol. 1988 May;5(2):127-9.[Abstract]
Ranki A, Hyry H, Klimenko T, et al. Update on current care guidelines. Bacterial skin infections [in Finnish]. Duodecim. 2010;126(24):2883-4.[Abstract]
1. Ofuji S, Ogino A, Horio T, et al. Eosinophilic pustular folliculitis. Acta Derm Venereol. 1970;50(3):195-203.[Abstract]
2. Majors MJ, Berger TG, Blauvelt A, et al. HIV-related eosinophilic folliculitis: a panel discussion. Semin Cutan Med Surg. 1997 Sep;16(3):219-23.[Abstract]
3. Lucky AW, Esterly NB, Heskel N, et al. Eosinophilic pustular folliculitis in infancy. Pediatric Dermatol. 1984 Jan;1(3):202-6.[Abstract]
4. Buckley DA, Munn SE, Higgins EM. Neonatal eosinophilic pustular folliculitis. Clinical Exp Dermatol. 2001 May;26(3):251-5.[Abstract]
5. Brodell RT, O'Brien MJ Jr. Topical corticosteroid-induced acne: three treatment strategies to break the 'addiction' cycle. 1999 Nov;106(6):225-6;229.[Abstract]
6. Bachet JB, Peuvrel L, Bachmeyer C, et al. Folliculitis induced by EGFR inhibitors, preventive and curative efficacy of tetracyclines in the management and incidence rates according to the type of EGFR inhibitor administered: a systematic literature review. Oncologist. 2012;17(4):555-68.[Abstract][Full Text]
7. Ramdial PK, Naidoo DK. Drug-induced cutaneous pathology. J Clin Pathol. 2009 Jun;62(6):493-504.[Abstract][Full Text]
8. Faergemann J. Pityrosporum infections. J Am Acad Dermatol. 1994 Sep;31(3 Pt 2):S18-20.[Abstract]
9. Halder RM. Pseudofolliculitis barbae and related disorders. Dermatol Clin. 1988 Jul;6(3):407-12.[Abstract]
10. Alexander AM, Delph WI. Pseudofolliculitis barbae in the military: a medical, administrative and social problem. J Natl Med Assoc. 1974 Nov;66(6):459-64;479.[Abstract][Full Text]
11. Ota T, Hata A, Tanikawa A, et al. Eosinophilic pustular folliculitis (Ofuji's disease): indomethacin as a first choice of treatment. Clin Exp Dermatol. 2001 Mar;26(2):179-81.[Abstract]
12. Porriño-Bustamante ML, Sánchez-López J, Aneiros-Fernández J, et al. Recurrent pustules on an infant's scalp with neonatal onset. Int J Dermatol. 2016 May;55(5):505-8.[Abstract]
13. Hernández-Martín Á, Nuño-González A, Colmenero I, et al. Eosinophilic pustular folliculitis of infancy: a series of 15 cases and review of the literature. J Am Acad Dermatol. 2013 Jan;68(1):150-5.[Abstract]
14. Otberg N, Kang H, Alzolibani AA, et al. Folliculitis decalvans. Dermatol Ther. 2008 Jul-Aug;21(4):238-44.[Abstract]
15. Miguel-Gómez L, Rodrigues-Barata AR, Molina-Ruiz A, et al. Folliculitis decalvans: effectiveness of therapies and prognostic factors in a multicenter series of 60 patients with long-term follow-up. J Am Acad Dermatol. 2018 Nov;79(5):878-83.[Abstract]
16. Zouboulis CC, Bechara FG, Dickinson-Blok JL, et al. Hidradenitis suppurativa/acne inversa: a practical framework for treatment optimization - systematic review and recommendations from the HS ALLIANCE working group. J Eur Acad Dermatol Venereol. 2019 Jan;33(1):19-31.[Abstract][Full Text]
17. Yamasaki O, Kaneko J, Morizane S, et al. The association between Staphylococcus aureus strains carrying panton-valentine leukocidin genes and the development of deep-seated follicular infection. Clin Infect Dis. 2005 Feb 1;40(3):381-5.[Abstract][Full Text]
18. Lee B, Kang HY. Molluscum folliculitis after leg shaving. J Am Acad Dermatol. 2004 Sep;51(3):478-9.[Abstract]
19. Tempark T, Shwayder TA. Perioral dermatitis: a review of the condition with special attention to treatment options. Am J Clin Dermatol. 2014 Apr;15(2):101-13.[Abstract]
20. Wohlrab J, Wohlrab D, Meiss F. Skin diseases in diabetes mellitus. J Dtsch Dermatol Ges. 2007 Jan;5(1):37-53.[Abstract]
21. Suaya JA, Eisenberg DF, Fang C, et al. Skin and soft tissue infections and associated complications among commercially insured patients aged 0-64 years with and without diabetes in the US. PLoS One. 2013;8(4):e60057.[Abstract][Full Text]
22. Osborne GE, Taylor C, Fuller LC. The management of HIV-related skin disease. Part I: infections. Int J STD AIDS. 2003 Feb;14(2):78-86;quiz 87-8.[Abstract]
23. Boral H, Durdu M, Ilkit M. Majocchi's granuloma: current perspectives. Infect Drug Resist. 2018 May 22;11:751-60. [Abstract][Full Text]
24. Šikić Pogačar M, Maver U, Marčun Varda N, et al. Diagnosis and management of diaper dermatitis in infants with emphasis on skin microbiota in the diaper area. Int J Dermatol. 2018 Mar;57(3):265-75.[Abstract]
25. Wolff K, Johnson RA, Suurmond R. Infectious folliculitis. In: Wolff K, Johnson RA, Suurmond R, eds. Fitzpatrick's color atlas & synopsis of clinical dermatology. New York, NY: McGraw-Hill Professional; 2005:979-85.
26. Leclerc G, Weber M, Contet-Audonneau N, et al. Candida folliculitis in heroin addicts. Int J Dermatol. 1986 Mar;25(2):100-2.[Abstract]
27. Sabota J, Brodell R, Rutecki GW, et al. Severe tinea barbae due to Trichophyton verrucosum infection in dairy farmers. Clin Infect Dis. 1996 Dec;23(6):1308-10.[Abstract][Full Text]
28. Rubenstein RM, Malerich SA. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. 2014 Mar;7(3):37-41.[Abstract][Full Text]
29. Luelmo-Aguilar J, Santandreu MS. Folliculitis: recognition and management. Am J Clin Dermatol. 2004;5(5):301-10.[Abstract]
30. Karincaoglu Y, Bayram N, Aycan O, et al. The clinical importance of demodex folliculorum presenting with nonspecific facial signs and symptoms. J Dermatol. 2004 Aug;31(8):618-26.[Abstract]
31. Wald A, Huang ML, Carrell D, et al. Polymerase chain reaction for detection of herpes simplex virus (HSV) DNA on mucosal surfaces: comparison with HSV isolation in cell culture. J Infect Dis. 2003 Nov 1;188(9):1345-51.[Abstract][Full Text]
32. Sakai K, Wakasugi S, Muchemwa FC, et al. Quick detection of herpes viruses from skin vesicles and exudates without nucleic acid extraction using multiplex PCR. Biosci Trends. 2008 Aug;2(4):164-8.[Abstract][Full Text]
33. Ishibashi A, Nishiyama Y, Miyata C, et al. Eosinophilic pustular folliculitis (ofuji). Dermatologica. 1974;149(4):240-7.[Abstract]
34. Oranje AP, Folkers E. The Tzanck smear: old, but still of inestimable value. Pediatr Dermatol. 1988 May;5(2):127-9.[Abstract]
35. Nussbaum D, Friedman A. Pseudofolliculitis barbae: a review of current treatment options. J Drugs Dermatol. 2019 Mar 1;18(3):246-50.[Abstract]
36. Pinkus H. Alopecia mucinosa: inflammatory plaques with alopecia characterized by root sheath mucinosis. AMA Arch Derm. 1957 Oct;76(4):419-24.[Abstract]
37. Johnson WC, Higdon RS, Helwig EB. Alopecia mucinosa. AMA Arch Derm. 1969;79:395-406.
38. Vermandere M, Aertgeerts B, Agoritsas T, et al. Antibiotics after incision and drainage for uncomplicated skin abscesses: a clinical practice guideline. BMJ. 2018 Feb 6;360:k243.[Abstract][Full Text]
39. Stulberg DL, Penrod MA, Blatny RA. Common bacterial skin infections. Am Fam Physician. 2002 Jul 1;66(1):119-24.[Abstract][Full Text]
40. Ranki A, Hyry H, Klimenko T, et al. Update on current care guidelines. Bacterial skin infections [in Finnish]. Duodecim. 2010;126(24):2883-4.[Abstract]
41. Neubert U, Plewig G, Ruhfus A. Treatment of gram-negative folliculitis with isotretinoin. Arch Dermatol Res. 1986;278(4):307-13.[Abstract]
42. Leyden JJ, Marples RR, Mills OH Jr, et al. Gram-negative folliculitis - a complication of antibiotic therapy in acne vulgaris. Br J Dermatol. 1973 Jun;88(6):533-8.[Abstract]
43. European Medicines Agency. Quinolone- and fluoroquinolone-containing medicinal products. March 2019 [internet publication].[Full Text]
44. US Food and Drug Administration. FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes. July 2018 [internet publication].[Full Text]
45. US Food and Drug Administration. FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients. December 2018 [internet publication].[Full Text]
46. Durdu M, Güran M, Kandemir H, et al. Clinical and laboratory features of six cases of Candida and dermatophyte folliculitis and a review of published studies. Mycopathologia. 2016 Feb;181(1-2):97-105.[Abstract]
47. Wendt C, Schinke S, Württemberger M, et al. Value of whole-body washing with chlorhexidine for the eradication of methicillin-resistant Staphylococcus aureus: a randomized, placebo-controlled, double-blind clinical trial. Infect Control Hosp Epidemiol. 2007 Sep;28(9):1036-43.[Abstract]
48. Falagas ME, Bliziotis IA, Fragoulis KN. Oral rifampin for eradication of Staphylococcus aureus carriage from healthy and sick populations: a systematic review of the evidence from comparative trials. Am J Infect Control. 2007 Mar;35(2):106-14.[Abstract]
49. Micek ST. Alternatives to vancomycin for the treatment of methicillin-resistant Staphylococcus aureus infections. Clin Infect Dis. 2007 Sep 15;45(suppl 3):S184-90.[Abstract][Full Text]
50. Russo A, Concia E, Cristini F, et al. Current and future trends in antibiotic therapy of acute bacterial skin and skin-structure infections. Clin Microbiol Infect. 2016 Apr;22(suppl 2):S27-36.[Abstract][Full Text]
51. Abrahamian FM, Sakoulas G, Tzanis E, et al. Omadacycline for acute bacterial skin and skin structure infections. Clin Infect Dis. 2019 Aug 1;69(suppl 1):S23-32.[Abstract][Full Text]
52. Stets R, Popescu M, Gonong JR, et al. Omadacycline for community-acquired bacterial pneumonia. N Engl J Med. 2019 Feb 7;380(6):517-27.[Abstract][Full Text]
53. Rambhia PH, Conic RRZ, Murad A, et al. Updates in therapeutics for folliculitis decalvans: a systematic review with evidence-based analysis. J Am Acad Dermatol. 2019 Mar;80(3):794-801.[Abstract][Full Text]
