Folliculitis in Child
See also in: Anogenital,Hair and ScalpAlerts and Notices
Synopsis
The etiology of folliculitis can be variable, with bacterial, fungal (eg, candidiasis), viral, parasitic, and noninfectious causes reported. A detailed history of comorbid conditions, exposures, and medications, in conjunction with appropriate ancillary testing, can be helpful.
Specifically in children, bacterial causes such as Staphylococcus are common, as well as yeast, including Pityrosporum. Statistically, children in day care facilities and athletes are at higher risk for community-acquired methicillin-resistant S. aureus (MRSA) infection, so suspicion should be high.
Pseudomonal folliculitis has been seen in children following use of a hot tub at a pool party. A similar folliculitis in children who used recreational water facilities has been reported secondary to Aeromonas hydrophila.
Although Demodex folliculitis is very rare in children younger than age 2, one study reported a series of cases in immunocompetent children between 10 months and 5 years of age. It has also been noted in immunosuppressed children with acute lymphoblastic leukemia.
Noninfectious folliculitis may also be considered. Eosinophilic pustular folliculitis is a variant of Ofuji disease and is characterized by pruritic pustules on the scalp and peripheral leukocytosis with eosinophilia. While it has been reported frequently in infancy (eosinophilic pustular folliculitis in infancy), a childhood case was reported following bone marrow transplantation in a patient with aplastic anemia.
As expected, children who are immunosuppressed are at risk for folliculitis. One study of pediatric dermatology consultations in children with organ transplantations noted that impetigo contagiosum and folliculitis accounted for 6.2% of the cases encountered (see also immunosuppression-associated eosinophilic folliculitis).
Medication-induced folliculitis should also remain on the differential. Medications that can cause folliculitis include corticosteroids, halogens (potassium iodide, radiocontrast media), and lamotrigine.
Codes
ICD10CM:L73.8 – Other specified follicular disorders
SNOMEDCT:
13600006 – Folliculitis
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Differential Diagnosis & Pitfalls
Consider organisms other than Staphylococcus such as:- Pseudomonas folliculitis (hot tub folliculitis)
- Pityrosporum folliculitis
- Folliculitis due to herpes simplex virus (HSV) or varicella zoster virus (VZV)
- Demodex folliculitis
- Molluscum contagiosum folliculitis
Other dermatoses in the differential diagnosis:
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:03/01/2017
Last Updated:08/16/2021
Last Updated:08/16/2021
Patient Information for Folliculitis in Child
Overview
Folliculitis is a skin condition caused by inflammation of the hair follicles. It usually occurs in areas where the skin is irritated by friction, such as rubbing from clothes. In most instances of folliculitis, the inflamed follicles are infected with bacteria, especially the type called Staphylococcus (or "staph"), that normally live on the skin. Bacteria such as Pseudomonas may live in hot tubs, spas, and swimming pools and may also cause folliculitis.Who’s At Risk
Folliculitis occurs in people of all ages, races / ethnicities, and sexes. It is very common in children.Risk for folliculitis is increased by:
- Skin conditions such as eczema, acne, or another dermatitis.
- Excessive sweating.
- Living in a warm, humid climate.
- Diabetes.
- Obesity.
- A weakened immune system due to organ transplantation, cancer, or HIV/AIDS.
- Frequent shaving.
Signs & Symptoms
The most common locations for folliculitis in children include the:- Scalp.
- Face.
- Buttocks.
- Arms and legs.
Both mild and moderate folliculitis are often tender or itchy. More severe folliculitis, which may be deeper and may affect the entire hair follicle, can be painful.
Mild and moderate folliculitis usually go away quickly with treatment and leave no scars. More severe folliculitis may lead to more serious complications, such as an infection of the deeper skin tissue (called cellulitis), scarring, and permanent hair loss in the affected area.
Self-Care Guidelines
To prevent folliculitis, have your child try:- Avoiding tight clothing, especially during exercise.
- Washing athletic clothing after each use.
- Use an antibacterial wash (eg, PanOxyl Acne Creamy Wash, Hibiclens).
- Apply hot, moist compresses to the affected area.
- Use an over-the-counter corticosteroid cream (hydrocortisone) to help soothe irritated or itchy skin.
- Wash towels, washcloths, and bed linens often.
- Wear loose-fitting clothes.
When to Seek Medical Care
See your child's pediatrician, dermatologist, or another medical professional 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 medical professional about any recent exposure to hot tubs, spas, and swimming pools because a less common form of folliculitis may be caused by bacteria living in 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 medical professional.
Treatments
Folliculitis is usually fairly easy to diagnose. Your child's medical professional may perform a bacterial culture and may recommend:- Prescription-strength antibacterial wash such as hexachlorophene (eg, pHisoDerm, pHisoHex).
- Topical antibiotic lotion or gel such as clindamycin (eg, Cleocin T).
- Oral antibiotic pills or syrups such as cephalexin (eg, Keflex), dicloxacillin (eg, Vibramycin, Monodox), trimethoprim-sulfamethoxazole (eg, Bactrim), or clindamycin (eg, Cleocin).
Folliculitis in Child
See also in: Anogenital,Hair and Scalp