Folliculitis

Clinical presentation and differential diagnosis

Folliculitis is characterized by purulent inflammation affecting exclusively the hair follicle. The lesions can be either single or multiple. The preferred localization of the pathological process is any skin area where long, well-developed vellus hairs are present.

An extremely crucial step is differential diagnosis with the anthrax carbuncle. The anthrax lesion (Bacillus anthracis, detected by microscopy of the discharge) has a completely different clinical picture:

• Absence of purulent discharge (unlike ordinary folliculitis).
• Complete absence of pain in the inflammatory infiltrate — this is one of the key differential signs.
• Presence of a hemorrhagic vesicle at the onset of the disease.
• Formation of dense, black necrotic tissue (escar).
• Presence of a "necklace" — small vesicles with hemorrhagic contents around the central escar.
• Marked edema of the surrounding soft tissues.

Conservative therapy

Conservative patient management is indicated at the initial stage of the purulent process development.

General measures: The basis of treatment is ensuring complete rest of the affected body part. Purulent processes on the face require special attention. In such cases, the patient is prescribed strict bed rest, liquid food, and forbidden to speak to achieve maximum immobilization of the facial muscles.

Local treatment:

• Thorough treatment of the skin surface with a 70% ethanol solution.
• Application of an aseptic dressing.
• Use of physical therapy (UHF therapy).

Drug support: Patients are prescribed parenteral administration of antibiotics and oral intake of long-acting sulfonamides. If the patient has concomitant diabetes mellitus, metabolic correction is critically important — careful insulin therapy contributes to a significant reduction of the infiltrate and a decrease in the risk of extensive necrosis.

Surgical treatment

If conservative therapy proves unsuccessful for 2–3 days, the necrosis zone increases, or purulent intoxication progresses, surgical intervention is indicated for the patient.

Surgical technique:

1. Anesthesia: the intervention is performed under general anesthesia.
2. Access: a cruciate incision is used.
3. Scope of intervention: the infiltrate is dissected down to the deep fascia. Excision of necrotic tissues (skin and subcutaneous fat) and wide opening of all purulent streaks are performed.
4. Hemostasis: bleeding is generally insignificant due to vascular thrombosis in the inflammation zone. Hemostasis is achieved by tight packing using hypertonic NaCl solution or proteolytic enzyme preparations.

Facial surgery specifics: Surgical treatment of purulent foci (carbuncles) on the face has strict rules: incision is performed only after abscess formation, while the cruciform incision is replaced with a less traumatic linear one.

In the postoperative period, the wound is managed according to the classical principles of purulent wound treatment. Proteolytic enzymes are actively used for final cleansing and rejection of necrotic masses.

Class and exam questions

What else to study on this topic

• Microscopic diagnosis of Bacillus anthracis
• Principles of purulent wound management in the postoperative period
• Mechanism of action of proteolytic enzymes in necrosis
• Features of antibiotic therapy in purulent skin infections

Other topics from the section "CHAPTER 11. SURGICAL INFECTION (PURULENT-INFLAMMATORY DISEASES)"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.