Folliculitis  A parent's guide to condition and treatment information

Folliculitis occurs in people of all races, of all ages, and of both sexes. It is very common in children.

Risk for folliculitis is increased by:

• Skin conditions such as eczema, acne, or another dermatitis
• Excessive sweating due to regular exercise
• Living in a warm, humid climate
• Diabetes
• Obesity
• Weakened immune system due to HIV/AIDS, organ transplantation, or cancer
• Frequent shaving

The most common locations for folliculitis in children include:

• Scalp
• Face
• Buttocks
• Arms and legs

Individual lesions of folliculitis are pus-filled bumps (pustules) centered on hair follicles. These pustules may be pierced by an ingrown hair, can vary in size from 2–5 mm, and are often surrounded by a rim of pink-to-red, inflamed skin. Occasionally, a folliculitis lesion can break open (rupture) to form a scab on the surface of the skin.

Both mild and moderate folliculitis are often tender or itchy. More severe folliculitis, which may be deeper and may affect the entire hair follicle, may be painful.

Mild and moderate folliculitis usually go away quickly with treatment and leave no scars. However, more severe folliculitis may lead to more serious complications, such as an infection of the deeper skin tissue (called cellulitis), scarring, or permanent hair loss.

To prevent folliculitis, have your child try the following:

• Avoid tight clothing, especially during exercise.
• Wash athletic clothing after each use.

To help clear up mild folliculitis:

• Use an antibacterial soap.
• Apply hot, moist compresses to the affected area.
• Use an over-the-counter corticosteroid lotion (cortisone) to help soothe irritated or itchy skin.
• Wash towels, washcloths, and bed linens often.
• Wear loose-fitting clothes.

See your child's doctor or a dermatologist if self-care measures do not heal the condition within 2 or 3 days, if symptoms keep coming back, or if the infection spreads to larger areas or appears somewhere else on the body.

Tell your child's doctor about any recent exposure to hot tubs, spas, or swimming pools, because a less common form of folliculitis may be caused by bacteria living in (contaminating) these water sources.

If your child is currently being treated for a skin infection that has not improved after 2–3 days of antibiotics, return to the child's doctor.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a strain of "staph" bacteria resistant to antibiotics in the penicillin family, which have been the cornerstone of antibiotic therapy for staph and skin infections for decades. CA-MRSA previously infected only small segments of the population, such as health care workers and persons using injection drugs. However, CA-MRSA is now a common cause of skin infections in the general population. While CA-MRSA bacteria are resistant to penicillin and penicillin-related antibiotics, most staph infections with CA-MRSA can be easily treated by health care practitioners using local skin care and commonly available non-penicillin-family antibiotics. Rarely, CA-MRSA can cause serious skin and soft tissue (deeper) infections. Staph infections typically start as small red bumps or pus-filled bumps, which can rapidly turn into deep, painful sores. If you see a red bump or pus-filled bump on your child's skin that is worsening or showing any signs of infection (ie, the area becomes increasingly painful, red, or swollen), see the child's doctor right away. Many people believe incorrectly that these bumps are the result of a spider bite when they arrive at the doctor's office. Your doctor may need to test (culture) infected skin for MRSA before starting antibiotics. If your child has a skin problem that resembles a CA-MRSA infection or a culture that is positive for MRSA, the doctor may need to provide local skin care and prescribe oral antibiotics. To prevent spread of infection to others, infected wounds, hands, and other exposed body areas should be kept clean and wounds should be covered during therapy.

Folliculitis is usually fairly easy to diagnose. Your child's physician may perform a bacterial culture to determine the type of bacteria causing the folliculitis.

In the culture procedure, the doctor will:

1. Penetrate any blisters or pus-filled pockets with a needle, scalpel, or small blade (lancet).
2. Rub a sterile cotton swab across the skin to collect the sample.
3. Send the specimen away to a laboratory for evaluation.

If there are many bacteria present in the sample, the laboratory will usually have some idea of what type it is within 48–72 hours. However, the culture may take a full week or more to produce final results. In addition to identifying the type of bacteria that is causing the folliculitis, the laboratory usually performs a test (antibiotic sensitivity testing) to determine which antibiotics will be most effective in killing off the bacteria.

Depending on the culture results, your child's physician may recommend:

• Prescription-strength antibacterial wash such as hexachlorophene
• Topical antibiotic lotion or gel such as erythromycin or clindamycin
• Oral antibiotic pills or syrups such as cephalexin or erythromycin

Occasionally, the bacteria causing the infection may be resistant to treatment with the usual antibiotics (these are called methicillin-resistant Staphylococcus aureus, or MRSA). This infection can sometimes be more severe than other types of folliculitis. Depending on the circumstances, your child's doctor may consider more aggressive treatment that includes prescribing:

• A combination of 2 different oral antibiotics, including trimethoprim-sulfamethoxazole, clindamycin, amoxicillin, linezolid, or a tetracycline (tetracyclines are not recommended for children under 8 years of age)
• A topical medication, mupirocin ointment, to apply to the nostrils

If your child's doctor prescribes antibiotics, be sure the child takes the full course of treatment.