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Folliculitis

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Folliculitis

Back to Dermatologic Conditions Chapter

EtiologyFindings/ DistributionDiagnostic CluesManagement
*See Potential ARV Interactions, below.
Eosinophilic folliculitis (see photo in DermAtlasLink will take you outside the VA website. VA is not responsible for the content of the linked site.)Numerous, extremely itchy pustules on the face, neck, scalp, and trunk Mainly seen in patients with CD4 counts of <200 cells/µL

Can be seen during immune reconstitution in the first 3-6 months on ART

Very pruritic, especially on face
Itraconazole* 200-400 mg daily (for anti-eosinophilic effect)

Permethrin 5% can be used every other day from the waist up (for drying effect)

Should resolve after 6 months on ART
Pityrosporum folliculitis (see photo in DermAtlasLink will take you outside the VA website. VA is not responsible for the content of the linked site.)Erythematous papules and tiny pustules along hair follicles Looks like a milder version of bacterial folliculitis with much smaller lesions

Lesions are smaller and less pruritic than eosinophilic folliculitis

Commonly excoriated

Less likely to form large pustules

Overgrowth of tinea

Ketoconazole* 200 mg PO QD for 3 weeks

Follow with maintenance therapy using ketoconazole 2% shampoo twice weekly
Staphylococcus folliculitisErythematous papules and pustules along hair follicles Often excoriated

Often draining pus

Presents as an erythematous flare

MRSA common; consider culture to guide treatment
Presumptive treatment for MRSA:

  • TMP-SMX DS BID, or doxycycline 100 mg BID, treat for 10-14 days
  • If severe, IV antibiotics. Consider vancomycin or clindamycin
  • Nares should be treated with intranasal mupirocin QHS for 5 days
If confirmed MSSA:

  • dicloxacillin or cephalexin
Pseudomonal folliculitisPapular lesions appear within 8-48 hours after exposureAssociated with use of hot tub and wet suit/swimwear (lesions may be concentrated in areas covered by swimwear)

In immunocompetent persons, self-limited to 7-14 days
For immunosuppressed persons or those with prolonged or severe cases, consider treating with ciprofloxation for 10 days

From Dermatologic Conditions
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009