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Patient Story
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A young girl is seen for multiple papules and pustules on her lower abdomen (Figure 100-1). Further questioning demonstrates that she was in a friend’s hot tub twice over the previous weekend. The outbreak started after she went into the hot tub the second time. This is a case of Pseudomonas folliculitis or “hot tub” folliculitis. The patient avoided this hot tub and the folliculitis disappeared spontaneously.

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FIGURE 100-1

“Hot-tub” folliculitis from Pseudomonas aeruginosa in a hot tub. The folliculitis tends to be distributed under or around the bathing suit. (Used with permission from Daniel Stulberg, MD.)

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Introduction
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Folliculitis is an inflammation of hair follicles usually from an infectious etiology. Multiple species of bacteria have been implicated, as well as fungal organisms.

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Epidemiology
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  • Folliculitis is a cutaneous disorder that affects all age groups and races, and both genders.

  • It can be infectious or noninfectious. It is most commonly of bacterial origin (Figure 100-2).

  • Pseudofolliculitis barbae is most frequently seen in men of color and made worse by shaving (Figure 100-3).1 It is also known as “razor bumps” and can start in the teen years with the onset of shaving.

  • Acne keloidalis nuchae or keloidal folliculitis is commonly seen in black patients, but can be seen in patients of any ethnic background (Figures 100-4 and 100-5).2 Like pseudofolliculitis barbae, it is exacerbated by shaving.

  • Methicillin-resistant Staphylococcus aureus (MRSA) can pose a challenge to the treatment of folliculitis (Figure 100-6).

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FIGURE 100-2

Close-up of bacterial folliculitis showing hairs coming through pustules. A culture grew out Staphylococcus aureus. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 100-3

Pseudofolliculitis barbae in a young black man. Also known as “razor bumps” this started in his teen years with the onset of shaving. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 100-4

Acne keloidalis nuchae with inflamed papules and pustules on the neck of a young Hispanic man. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 100-5

Acne keloidalis nuchae with inflamed papules and pustules on the posterior neck and scalp of a young African American man who shaves his head. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 100-6

MRSA folliculitis in the axilla of a young woman. The lesions were present for 4 weeks in the axilla, left ...

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