Folliculitis and Chronic illnesses

Folliculitis may affect any person at any age or sex. Its an inflammatory condition of hair follicle. It is well distributed to parts of skin which have hair. The common sites are  scalp, face (including bearded area), armpits, chest and back, thighs and buttocks. It can occur in absence of any underlying illness with unhygienic living. But it has some known association with few underlying chronic debilitating diseases. What ever the underlying reason the lesion has typical red pimple, itchy, with a white head effecting one or more than one part of body. It does not effect palm of hand, sole, or mucous membranes.

Some chronic illnesses associated with follicultis are:

1) Diabetes and folliculitis: These individuals have weaker immune system as well as higher average blood sugar concentration, which provides favorable conditions for all kinds of yeast, fungi, and bacteria to infect. They show delayed healing of skin wounds.

2)  HIV and folliculitis: Whether asymptomatic HIV positive person or person suffering from AIDS has weakened ability to fight against micro-organism because of suppression of  immune system. Folliculitis with appearance of red pimples may be the first sign in HIV positive individuals. It almost always effects homosexual males and very rarely in HIV positive females.

Human immune deficiency virus related follicultis is commonly known as eosinophillic folliculitis.

Eosinophilic folliculitis: This type of folliculitis is almost always encountered in HIV positive or AIDS patients, for unknown reason. But it may occur in pediatric population and those receiving organ transplants. Skin eruption seen is erythematous, papules on the facial area including forehead, behind the ears, and neck. The other common sites are trunk, head and proximal extremities. It has itchiness. Eosinophilic folliculitis may be the first sign of immunosuppression in children or adults.

The eosinophilic folliculitis is commonly non-infectious and there is only infiltration of eosinophils inside hair follicles of effected area of skin. The classic presentation is pustular folliculitis.

Treatment of eosinophilic folliculitis is mainly based on topical application of steroids. Its anti-inflammatory and anti-pruritic effects makes folliculitis get better. Using any formulation of antihistamine is also quite beneficial in relieving irritating itch.

Highly active anti-retroviral therapy has changed the treatment response of most of skin condition in HIV patients, that includes eosinophilic folliculitis. It dramatically results in regression of folliculitis and speeds healing.

There are micro-organisms causing follicultis in HIV positive and AIDS patients. They  attack quite frequently in all immunocompromised individuals. They most commonly belong to class yeast, pityrosporum is the one responsible. It effects upper arms, chest, shoulder, back and occasionally face. Other common infestation is caused by mites of Demodex variety. Demodex effects facial area near nose, cheeks, eyelashes and eyebrows.

Treatment of  Demodex follicultis in HIV cases is to first identifying the mite. It is done by scrapping obtained from lesion at eyebrows treating it with hydrogen peroxide and examining under microscope.

A combination of crotamiton 10% and benzyl benzoate for two weeks on the affected area of the skin works wonders. It is not to be applied on eyes affected with demodex, as intense irritation can occurs. For eyebrow and eyelash infestation by demodex in HIV, combination of tobramycin and dexamthasone three times  daily for two to three weeks suffices.

Pityrosporum folliculitis in HIV patients is managed by adopting good personal hygiene, which is basic of treating any skin infection. Another ideal treatment is the application of local lotions and creams. Salicylic acid solution used after showers keeps the skin dry.

Ketoconazole shampoo 3-5 times weekly or as cream applied twice daily till the lesion is healed and organism eradicated. Econazole  cream can be used as second choice.

Selenium sulfide lotion is very effective applied daily for two weeks can eradicate pityrosporum yeast.

Oral anti-fungal itroconazole or fluconazole 100-200 mg once or twice daily for two weeks controls fungus effected folliculitis in HIV  patients.

The basics of personal hygiene always must be mainstay of management.