Folliculitis

Published on 11/06/2015 by admin

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Last modified 22/04/2025

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Section 3: Pustular Lesions

23

Folliculitis

DDx Ref 25 • 7 • 24

Folliculitis: Staphylococcal superficial folliculitis and ecthyma.

Folliculitis: Staphylococcal superficial folliculitis. Multiple pustules on a red base.

CLINICAL FEATURES

Folliculitis is seen as 1−2-mm discrete pustules restricted to follicular openings. In a few children with folliculitis, impetigo or ecthyma may also be seen. Most folliculitis is bacterial in origin and Staphylococcus aureus the most frequent pathogen. Occasionally, Pseudomonas aeruginosa or other Gram-negative bacteria will produce folliculitis in special circumstances such as ‘hot tub’ folliculitis.

Poor hygiene and warm moist conditions are predisposing factors as is air-tight skin occlusion and prolonged immersion in water. Ask about other family members or close contacts who may be affected. Bacterial cultures are not routinely done.

TREATMENT

Topical antibiotics and good skin hygiene are the mainstays of therapy. Topical mupirocin, erythromycin, clindamycin, retapamulin 1% or benzoyl peroxide 5% gel preparations should be used twice daily for 7 to 10 days.

Thorough hand washing with antibacterial soaps daily for the affected child, family members and close contacts. In recurrent or persistent cases, nasal carriage of S. aureus may be eliminated with mupirocin 1% nasal ointment daily for 5 days.

Oral anti-staph antibiotics such as dicloxacillin 15−50 mg/kg/day or cephalexin 40−50 mg/kg/day may be considered in severe infections or when impetigo or ecthyma is also present. In Gram-negative infections, proper chlorination of hot tubs or spas should be emphasized.

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