Pseudogolliculitis Barbae (PFB) and Folliculitis

Question 1

overview of what issue?
Inflammation of a hair follicle that can occur anywhere on the body where hair is found.

Answer 1

Folliculitis

Question 2

Most frequent Bacterial etiology for Folliculitis

Answer 2

S. aureus (+/- MRSA)
Strep
Pseudomonas

Question 3

What are some risk factors for foliculitis?

Answer 3

(1)Hair removal (shaving, plucking, waxing, epilating agents)
(2)Other pruritic skin conditions: eczema, scabies
(3)Occlusive dressing or clothing
(4)Personal carrier or contact with MRSA-infected persons
(5)Diabetes mellitus
(6)Immunosuppression
(7)Use of hot tubs or saunas
(8)Chronic antibiotic use (gram-negative folliculitis)
(9)Tattoo recipient
(10)Poor Hygiene

Question 4

What issue? What Tx?
(1) abrupt onset of follicular erythematous papules or pustules, with pruritus & pain in hairy areas.
(2) Rash occurs on hair-bearing skin, especially the face (beard), proximal limbs, scalp, and pubis.
(3) The clinical hallmark - hair emanating from the center of the pustule

Answer 4

Folliculitis
-ANTISEPTIC/SUPPORTIVE CARE IS USUALLY ENOUGH.

Question 5

Tx for Staphylococcal folliculitis

Answer 5

(a) Mupirocin ointment applied TID for 10 days
(b) Cephalexin: 250-500 mg PO QID (7-10 days)
(c) Dicloxacillin: 250-500 mg PO QID (7-10 days)

Question 6

Tx MRSA Folliculitis

Answer 6

(a) Bactrim DS: 1-2 tablets BID PO (5-10 days)
(b) Clindamycin: 300 mg PO TID (10 to 14 days)
(c) Doxycycline: 50-100 mg PO BID (5-10 days)

Question 7

Tx Pseudomonas folliculitis

Answer 7

(a) Ciprofloxacin: 500 to 750 mg PO BID for 7 to 14 days if lesions are persistent
(b) High-potency topical corticosteroids for inflammation
(c) Antihistamines (hydroxyzine, cetirizine) to control itching

Question 8

Tx Fungal folliculitis

Answer 8

(a) Topical antifungals: Ketoconazole 2% cream or shampoo or selenium sulfide shampoo daily
(b) Systemic antifungals for relapses fluconazole (100 to 200 mg/day for 3 weeks) oritraconazole (200 mg/day for 1 week) or griseofulvin (500 mg/day for 2 to 4 weeks)

Question 9

TX Parasitic folliculitis

Answer 9

5% permethrin: Apply to affected area, leave on for 8 hours, and wash off.

Question 10

Tx Herpetic folliculitis

Answer 10

(a)Valacyclovir: 500 mg PO TID for 5 to 10 days
(b)Acyclovir: 200 mg PO 5 times daily for 5 to 10 days

Question 11

General Treatment and Prevention Folliculitis

Answer 11

(1) Antiseptic and supportive care is usually enough. Systemic antibiotics may be used with questionable efficacy.
(2) Good hygiene practices.
(3) Wash hands frequently.
(4) Wash towels, clothes, and linens frequently with hot water to avoid reinfection.
(5) Good hair removal practices.
(6) Use witch hazel, alcohol, or Tend Skin afterward.

Question 12

Complications Folliculitis
(1) Primary complication is recurrent ______.
(2) Progression to ______ or abscesses
(3) Cellulitis

Answer 12

1) folliculitis
2) furunculosis

Question 13

Folliculitis ddx

Answer 13

-Folliculitis of other etiology
-Acne Vulgaris (if on face)
-Impetigo (if on face)

Question 14

______ folliculitis appears as a widespread rash, mainly on the trunk and limbs

Answer 14

Pseudomonal

Question 15

What issue?
(1) Red papules or pustules appear in the affected skin Lesions can be both painful and/or pruritic.
(2) Occurs in any area where the hair is shaved (scalp, posterior neck, groin, legs).
(3) Scarring and hyperpigmentation may result from this condition.
(4) Keloid formation is often a problem in affected skin, especially in African-American people.

Answer 15

Pseudofolliculitis Barbae

Question 16

What is the instruction regarding PFB

Answer 16

BUPERSINST 1000.22

Question 17

Tx for Mild to Moderate PFB

Answer 17

Treatment Approach 1 - Medical Treatment with Grooming Modifications
-Either a topical retinoid or eflornithine 13.9% (if available) and a temporary waiver of facial hair standards for up to 60 days

Question 18

Tx moderate to severe PFB

Answer 18

Treatment Approach 2 - Laser Hair Reduction with grooming modifications