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Dermatology Board Prep > DERM (05) Diseases of Cutaneous Adnexa > Folliculitis and other follicular disorders > Flashcards

Folliculitis and other follicular disorders Flashcards

1
Q

Four major types of infectious folliculitis?

A

Bacterial, Fungal, Viral, Other (demodex)

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2
Q

3 major types of bacterial folliculitis?

A

Staphylococcal aureus infxn, Gram-negative bacili, Hot tub folliculitis

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3
Q

3 major fungal folliculitis organisims?

A

Dermatophyte, Malassezia spp. (pityrosporum), Candida spp

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4
Q

2 major types of viral folliculitis?

A

HSV, VSV

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5
Q

5 major types of non-infectious folliculitis?

A

Culture-negative/normal flora, Irritant, drug-induced, Eosinophilic (3 types within it), disseminate and recurrent infundibulofolliculitis

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6
Q

5 major types of deep folliculitides?

A

Furuncles, Syncosis, Pseudofolliculitis barbae, acne keloidalis, follicular occlusion tetrad (1. Acne conglobata, Hidradenitis suppurativa, dissecting cellulitis of the scalp, pilonidal sinus/cyst)

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7
Q

How does folliculitis present clinically?

A

Follicular-based papules and pustules on an erythematous base. Often itchy and sometimes painful

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8
Q

What is the most common type of folliculitis?

A

Culture-negative, followed by bacterial folliculitis 2/2 to S. aureus

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9
Q

What are the 3 most common causes of gram-negative folliculitis?

A

Klebsiella, enterobacter, proteus

  • Also E. Coli
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10
Q

What is the most common location for bacterial folliculitis?

A

Face, trunk, axillae, buttocks

(areas under occlusion)

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11
Q

How to treat for S. aureus folliculitis?

A

Tx for nasal carriage with mupirocin TID x 7-10 days

Elston discusses using clindamycin as beta-lactams, TCN and Bactrim don’t penetrate the nose well

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12
Q

Common patient population to see gram-negative bacterial folliculitis in?

A

Favor acne pts on long-term abxs –> Pustules in T-zone and perinasal regions

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13
Q

What can be given in patients with severe gram-negative folliculitis/acne?

A
  • First: Topicals –> Gentamicin, BP
  • Second: Systemics –> Quinolones (cipro)
  • If severe and reucurrent –> Isotretinoin 0.5-1mg/kg/day
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14
Q

When does hot tub folliculitis occur after exposure?

A

Occurs after 12-48 hrs after hot tub/public facilities use

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15
Q

How does hot tub folliculitis present?

A

Presents with edematous pink-red follicular papules and pustules

  • Favors the trunk
  • Pruritic
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16
Q

Treatment for hot tub folliculitis?

A

Self-limited in most patients, in immunocompromised can do ciprofloxacin 500mg BID for 7-14 days

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17
Q

What organisms cause tinea barbae?

A

T. Mentagrophytes or T. verrucosum

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18
Q

Clinical of tinea barbae?

A

inflammatory papulopustules in beard area >> mustache with crusting, loosened hair can be removed w/o pain

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19
Q

Treatment of tinea barbae?

A

Tx with oral antifungals (griseofulvin, terbinafine, itraconazole)

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20
Q

What organism is often involved in Majocchi granuloma?

A

T. Rubrum

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21
Q

Clinical of Majocchi granuloma?

A

Presents with follicular pustules or nodules, pustules at edges of tinea cruris or corporis

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22
Q

Treatment of Majocchi granuloma?

A

Oral antifungals

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23
Q

Where can you often see Majocchi granuloma?

A

Women who shave their legs w/ blade razor

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24
Q

Clinical of malassezia folliculitis?

A

Presents with follicular papulopustules mainly on back, chest, and shoulders

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25
Q

Dx of malassezia folliculitis?

A

KOH prep of follicular contents

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26
Q

Clinical of candida folliculitis?

A

Presents with pruritic satellite pustules surrounding areas of intertriginous candidiasis

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27
Q

A population that is susceptible to HSV 1/2 folliculitis?

A

Men w/ history of recurrent herpes infxn who shave w/ blade razor (consider VZV in immunocompromised)

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28
Q

Clinical of demodex folliculitis?

A

Associated with immunosuppression and rosacea; p/w erythematous papulopustules on the face within a background of diffuse erythema

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29
Q

The population at risk for drug-induced folliculitis?

A

Most common in acne-prone pts and age groups

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30
Q

When does drug-induced folliculitis start after having used a drug?

A

Within 2 wks of starting drug

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31
Q

Is risk of drug-induced folliculitis related to dose?

A

Yes, risk is proportional to dose and duration of therapy

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32
Q

Clinical of drug-induced folliculitis?

A

Presents with monomorphic erythematous follicular papules and pustules (trunk, shoulders, upper arms), no true comedones

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33
Q

Most common medications to cause drug-induced folliculitis?

A

Steroids, androgenic hormones, EGFR inhibitors, iodides, lithium, isoniazid, anticonvulsants

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34
Q

What are the 3 variants of eosinophilic folliculitis?

A
  • Eosinophilic pustular folliculitis (Ofuji’s disease)
  • Immunosuppression-associated eosinophilic pustular folliculitis
  • Eosinophilic pustular folliculitis of infancy
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35
Q

Where is eosinophilic pustular folliculitis reported most commonly?

A

Japan

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36
Q

Is eosinophilic pustular folliculitis associated with systemic disease?

A

No

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37
Q

Clinical of eosinophilic pustular folliculitis?

A

Presents with recurrent episodes of PRURITIC follicular papulopustules → erythematous patches and plaques with superimposed coalescent pustules → central clearing (figurate lesions) - lesions last 7-10 d and course is spontaneous resolution with relapses as the norm

38
Q

What lab abnormalities can be seen in eosinophilic pustular folliculitis?

A

Blood eosinophilia

39
Q

Treatment for eosinophilic pustular folliculitis?

A

Indomethacin 50mg/day

40
Q

Epidemiology of Immunosuppression-associated eosinophilic pustular folliculitis?

A

Disease activity correlates with low CD4 count (<300), also a/w iatrogenic immunosuppression and leukemia/lymphoma/hSCT pts, can be a part of immune reconstitution syndrome

41
Q

Clinical of Immunosuppression-associated eosinophilic pustular folliculitis?

A

Presents with chronic, pruritic follicular papules, less pustular than Ofuji’s, favor face, scalp, upper trunk

42
Q

Treatment for Immunosuppression-associated eosinophilic pustular folliculitis?

A

Tx HIV/AIDS, improvement with an elevation of CD4 count, UVB phototherapy for pruritus, topical tacrolimus, permethrin, oral abx

43
Q

What is Eosinophilic pustular folliculitis of infancy?

A

Unusual self-limiting d/o mainly on scalp and brow region, secondary crusting often seen - self-limited course

44
Q

What are the hallmark findings in keratosis pilaris atrophicans?

A

Abnormal follicular keratinization + atrophy + scarring alopecia

45
Q

What are the main treatments for keratosis pilaris atrophicans?

A

Combination of keratolytics, topical or oral retinoids, topical or intralesional steroids, IPL

46
Q

Mode of inheritance for keratosis pilaris atrophicans faciai (ulerythema aphryogenes)

A

AD

47
Q

Age of onset for keratosis pilaris atrophicans faciai?

A

Infancy

48
Q

Distribution for keratosis pilaris atrophicans faciai?

A

Eyebrows, particularly the lateral third (alopecia), temples, cheeks, forehead.

49
Q

Cutaneous features of keratosis pilaris atrophicans faciai?

A

Erythematous follicular papules w/ central keratotic plugs, eventuating in follicular atrophy. Scarring alopecia of the lateral eyebrows

50
Q

What syndromes/diseases is keratosis pilaris atrophicans faciai associated with?

A

Noonan syndrome, cardio-facio-cutaneous syndrome, wooly hair, and Cornelia de Lange syndrome

51
Q

Age of onset for atrophoderma vermiculatum?

A

Childhood (usually 5-12 years)

52
Q

What is the distribution of atrophoderma vermiculatum?

A

Cheeks, preauricular area, upper lip

53
Q

Cutaneous lesions in atrophoderma vermiculatum?

A

Associated with ipsilateral congenital cataract, Loeys-Dietz, Rombo, and Nicolau-Balus syndrome

54
Q

Genetics of keratosis folicularis spinulosa decalvans (x-linked)?

A

XR

55
Q

Age of onset for keratosis folicularis spinulosa decalvans (x-linked)?

A

Childhood (inflammation often remits at puberty

56
Q

Distribution for keratosis folicularis spinulosa decalvans (x-linked)?

A

Face, scalp, limbs, trunk

57
Q

Cutaneous features of keratosis folicularis spinulosa decalvans (x-linked)?

A

Erythematous follicualr papules with central keratotic plugs, eventuating in follicular atrophy, scarring alopecia of the scalp, eyebrows and eyelashes

58
Q

What other features is keratosis folicularis spinulosa decalvans (x-linked) associated with?

A

Variable facial erythema, nail dystrophy and palmoplantar keratoderma, keratitis, blepharitis, photophobia

59
Q

Genetics for keratosis follicularis spinulosa decalvans (folliuclitis spinulosa decalvans)?

A

AD

60
Q

Age of onset forkeratosis follicularis spinulosa decalvans (folliuclitis spinulosa decalvans)?

A

Puberty (onset or worsening)

61
Q

Distribution of keratosis follicularis spinulosa decalvans (folliuclitis spinulosa decalvans)?

A

Scalp

62
Q

Cutaneous presentation of keratosis follicularis spinulosa decalvans (folliuclitis spinulosa decalvans)?

A

Follicular pustules, features of keratosis follicularis spinulsa decalvans, x-linked

63
Q

What other features may be seen with keratosis follicularis spinulosa decalvans (folliuclitis spinulosa decalvans)?

A

Variable facial erythema and nail dystrophy, blepharitis, conjunctivitis, keratitis, photophobia

64
Q

Presentation of lichen spinulosus?

A

Grouped, skin-colored follicular papule on the extensor surface of the arm. You can also see central keratitis plugs.

65
Q

What are the 4 types of sycosis?

A

Barbae, lupoid, mycotic, and herpetic

66
Q

What is sycosis barbae?

A

Bacterial folliculitis of the beard or mustache areas, usually caused by Staph aureus. appears deep-seated, edematous, perifollicular papule and pustules that may coalesce to form plaques student w/ pustules and crusts

67
Q

What is lupoid sycosis?

A

Scarring from deep folliculitis that is more prominent in the beard areas.

  • May be caused by S. Aureus.
  • The name comes from the peripheral extension of perifollicular papule and pustules w/ central atopic scarring/cicatricial alopecia; granulomatous inflammation can lead to appearance reminiscent of lupus vulgarisms.
68
Q

What is mycotic syncosis?

A

Dermatophyte folliculitis of the beard area, most often the chin which is usually caused by zoophilic organisms. - Presents with inflammatory perifollicular papule and pustules coalescing to form nodules and plaques w/ purulent discharge from patulous follicles, crusting and loose hairs that can be painlessly removed.

69
Q

What is the treatment for pseudofolliculitis barbae?

A

Cure is laser hair removal with 1064 nm ND:YAG laser with long pulse duration or modified 810 nm super-long-pulsed diode laser

70
Q

What is the genetic predisposition for pseudofolliculitis barbae?

A

Mutation in 1A alpha-helical subdomain of hair follicle companion layer-specific keratin K6hf (K75).

71
Q

What is acne keloidalis nuchae?

A

Begins as chronic folliculitis of posterior neck and occipital scalp but then evolves into keloidal papule and plaques.

72
Q

Epidemiology of acne keloidalis nuchae?

A

Seen in darker prototypes, almost exlusively in black men

73
Q

Treatments for acne keloidalis nuchae?

A
  • Tretinoin gel and potent CS get twice daily (for non-inflamed papule and plaques
  • Hair removal for papule
  • Excision w/ punch or surgical depending on size
  • Imiquimod
74
Q

What is hidradenitis suppurativa?

A

Pathology of the apocrine gland bearing skin sites (axilla/groin/etc)

75
Q

Epidemiology of hidradenitis suppurativa?

A

Black F>>M, onset puberty

76
Q

clinical of hidradenitis suppurativa?

A

Stage pt according to hurley stages. clinically see recurrent furuncles and draining sinus tracts → scarring

77
Q

Morbdities of hidradenitis suppurativa?

A

anemia of chronic disease, secondary amyloidosis, lymphedema, fistulas, arthropathy, SCC within chronic scars

78
Q

General treatment of HS for all patients?

A
  • Weight reduction if obese or overweight
  • Measures to reduce friction and moistures like loose undergarments, absorbent powders, antiseptic soaps, topical aluminum chloride
  • Warm compresses
  • Stopping smoking
79
Q

What is Hurley stage I disease for HS?

A

Solitary or multiple isolated abscesses, no scarring or sinus tracts

80
Q

Treatment for Hurley stage I disease in HS?

A

ILK, topical clindamycin, eradicate S aureus, oral antibiotic therapy (tetracycline, doxycycline, clindamycin, rifampin + clindamycin, dapsone, Bactrim)

81
Q

What is Hurley stage II disease in HS?

A

Recurrent abscesses, sinus tract formation, early scarring

82
Q

Treatment for Hurley stage II disease?

A

Systemic adjuvant or maintenance therapy (acitretin, infliximab, cyclosporin)

  • Surgical treatment
83
Q

What is Hurley stage III disease?

A

Diffuse or broad involvement with multiple interconnected abscesses and sinus tracts.
- More extensive scarring

84
Q

Tx for Hurley stage II dz?

A

Early wide surgical excision to involved areas -CO2 laser ablation w/ secondary intention healing.

85
Q

What is trichostasis spinulosa?

A

Asymptomatic comedo-like lesions containing keratin and multiple vellus hairs mainly on face (mid to lower central portion)

86
Q

What is the typical scenario of a patient with viral -associated trichodysplasia?

A

Seen in drug-induced immunosuppression with cyclosporine

87
Q

What is the clinical of viral -associated trichodysplasia?

A

Presents with skin-colored to pink follicular papules and follicular spines (central face → loss of eyebrows and eyelashes)

88
Q

What virus is viral-associated trichodysplasia associated with?

A

Polyomavirus

89
Q

Treatment for viral -associated trichodysplasia?

A

Reduced immunosuppression if possible, otherwise topical cidofovir or tazarotene or oral valganciclovir

90
Q

Important components of Pityrosporum folliculitis histologically?

A
  • Pityrosporum can be seen normally in the follicular infundibulum
  • Pityrosporum should be deeper, and there needs to be eosinophils associated with the folliculitis

DERM (05) Diseases of Cutaneous Adnexa (5 decks)

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