Tufted Folliculitis

Tufted folliculitis is a rare and chronic skin disorder that affects the hair follicles, causing inflammation, redness, and the development of small bumps or nodules. The condition can occur in both men and women and typically affects the scalp, although it can also affect other parts of the body. In this article, we will explore the definition and different types of tufted folliculitis, as well as its causes, symptoms, diagnosis, and treatment options.

Definition of Tufted Folliculitis:

Tufted folliculitis is a rare and chronic skin disorder that affects the hair follicles. The condition is characterized by the formation of small bumps or nodules, which are typically located on the scalp but can also occur on other parts of the body. The term “tufted” refers to the appearance of the hair follicles, which become twisted and tangled, forming tufts of hair.

Types of Tufted Folliculitis:

There are two main types of tufted folliculitis:

Primary Tufted Folliculitis: Primary tufted folliculitis (PTF) is a rare and chronic condition that affects the hair follicles on the scalp. It is characterized by the formation of small bumps or nodules, which are typically red, inflamed, and itchy. The bumps may be filled with pus or other fluids, and the hair follicles become twisted and tangled, forming tufts of hair. PTF is more common in men than women and typically occurs in adults between the ages of 20 and 50.
Secondary Tufted Folliculitis: Secondary tufted folliculitis (STF) is a rare condition that occurs as a complication of another skin disorder. It is characterized by the formation of small bumps or nodules, which are typically located on the scalp but can also occur on other parts of the body. STF is most commonly associated with conditions such as acne, dermatitis, and folliculitis decalvans.

Causes

Most common causes of tufted folliculitis.

Pseudomonas aeruginosa: Pseudomonas aeruginosa is a bacteria commonly found in soil and water. It can infect the hair follicles and cause tufted folliculitis. This bacteria is particularly found in hot tubs, swimming pools, and other water sources.
Dermatophytes: Dermatophytes are a group of fungi that can infect the skin, hair, and nails. These fungi can infect the hair follicles and cause tufted folliculitis.
Malassezia folliculitis: Malassezia is a type of yeast that normally lives on the skin. It can overgrow in the hair follicles and cause tufted folliculitis.
Genetic factors: There is some evidence to suggest that tufted folliculitis may have a genetic component. Some studies have found that the condition can run in families.
Immune system dysfunction: Disorders of the immune system can affect the hair follicles and cause tufted folliculitis.
HIV: HIV infection can cause immune system dysfunction, which in turn can lead to tufted folliculitis.
Use of immunosuppressive drugs: Drugs that suppress the immune system can make individuals more susceptible to tufted folliculitis.
Topical corticosteroids: Topical corticosteroids are commonly used to treat various skin conditions. However, prolonged use of these medications can cause tufted folliculitis.
Antibiotics: Antibiotics can disrupt the normal balance of bacteria on the skin and lead to tufted folliculitis.
Hot and humid climates: Hot and humid climates can create a favorable environment for bacteria and fungi to grow, increasing the risk of tufted folliculitis.
Scalp trauma: Trauma to the scalp, such as from hair styling or scalp scratching, can cause inflammation of the hair follicles and lead to tufted folliculitis.
Tight hairstyles: Tight hairstyles, such as braids and weaves, can put pressure on the hair follicles and cause inflammation, leading to tufted folliculitis.
Hair products: Certain hair products, such as oils and gels, can clog the hair follicles and lead to tufted folliculitis.
Contact dermatitis: Contact dermatitis is a type of skin inflammation caused by contact with an irritant or allergen. It can lead to tufted folliculitis if it affects the hair follicles.
Seborrheic dermatitis: Seborrheic dermatitis is a common skin condition that affects the scalp. It can cause inflammation of the hair follicles and lead to tufted folliculitis.
Follicular occlusion syndrome: Follicular occlusion syndrome is a group of conditions that cause blockage of the hair follicles. It can lead to tufted folliculitis.
Acne keloidalis nuchae: Acne keloidalis nuchae is a condition that affects the hair follicles at the back of the neck. It can cause tufted folliculitis.

Symptoms

The symptoms of tufted folliculitis can vary from person to person, and can also change over time. However, there are some common symptoms that are often seen in people with the condition. Here are 20 possible symptoms of tufted folliculitis:

Multiple small papules: These are small bumps that are often closely grouped together, giving the appearance of a tuft.
Redness: The skin around the affected area may be red or inflamed.
Itching: The bumps may be itchy, which can cause discomfort and irritation.
Burning sensation: Some people may experience a burning sensation in the affected area.
Soreness: The scalp may be sore to the touch.
Crusting: The bumps may become crusted or scabbed over.
Scaling: The affected skin may become scaly or flaky.
Hair loss: The hair in the affected area may become thinner or fall out.
Abscesses: In some cases, the bumps may become infected and form abscesses.
Pain: The affected area may be painful or tender to the touch.
Swelling: The bumps may cause the surrounding skin to become swollen.
Oozing: In some cases, the bumps may ooze pus or other fluids.
Bleeding: The bumps may bleed, especially if they are scratched or picked at.
Worsening symptoms: Symptoms may worsen over time, or during periods of stress or illness.
Recurring symptoms: Symptoms may come and go, with periods of flare-ups followed by periods of remission.
Misdiagnosis: Tufted folliculitis is a rare condition that may be misdiagnosed as other skin conditions, such as acne or seborrheic dermatitis.
Frustration: The chronic nature of the condition can lead to frustration and a sense of hopelessness.
Emotional impact: The visible nature of the condition can cause embarrassment and affect self-esteem.
Social impact: The condition may limit social interactions and cause discomfort in public settings.
Difficulty finding effective treatment: There is no known cure for tufted folliculitis, and treatment options may be limited or ineffective.

In summary, tufted folliculitis is a chronic inflammatory condition that affects hair follicles, causing multiple small papules that are closely grouped together. Symptoms may include redness, itching, burning, soreness, crusting, scaling, hair loss, abscesses, pain, swelling, oozing, bleeding, worsening or recurring symptoms, misdiagnosis, frustration, emotional and social impact, and difficulty finding effective treatment

Diagnosis

To diagnose tufted folliculitis, a dermatologist may recommend various diagnostic tests and procedures. In this article, we will discuss 20 common diagnoses and tests used to diagnose tufted folliculitis.

Physical examination: A dermatologist will perform a thorough physical examination of the scalp and skin to check for the presence of small, itchy papules and pustules.
Skin biopsy: A skin biopsy involves the removal of a small sample of skin tissue for examination under a microscope. This test can help confirm the diagnosis of tufted folliculitis by revealing the characteristic features of the condition.
Microscopic examination: A dermatologist may examine skin scrapings or fluids from the affected area under a microscope to look for signs of infection or inflammation.
Bacterial culture: A bacterial culture involves collecting a sample of skin tissue or fluid and growing it in a laboratory to identify the type of bacteria present.
Fungal culture: A fungal culture involves collecting a sample of skin tissue or fluid and growing it in a laboratory to identify the type of fungus present.
Blood tests: Blood tests can help identify underlying health conditions that may be contributing to the development of tufted folliculitis, such as autoimmune disorders or infections.
Skin allergy tests: Skin allergy tests can help identify any allergens that may be triggering the development of tufted folliculitis.
Patch tests: Patch tests involve applying small amounts of different substances to the skin to see if an allergic reaction occurs.
Skin prick tests: Skin prick tests involve pricking the skin with a small amount of a potential allergen to see if an allergic reaction occurs.
Immunofluorescence tests: Immunofluorescence tests involve using fluorescent dyes to label specific proteins or cells in the skin. This can help identify any abnormalities in the skin cells that may be contributing to the development of tufted folliculitis.
Polymerase chain reaction (PCR) tests: PCR tests involve amplifying DNA or RNA samples from the skin to detect the presence of specific viruses or bacteria.
Antibody tests: Antibody tests involve detecting the presence of specific antibodies in the blood that may indicate an underlying infection or autoimmune disorder.
CT scans: CT scans can help identify any abnormalities in the tissues surrounding the affected area, such as enlarged lymph nodes.
Magnetic resonance imaging (MRI) scans: MRI scans can help identify any abnormalities in the tissues surrounding the affected area, such as enlarged lymph nodes.
Ultrasonography: Ultrasonography can help identify any abnormalities in the tissues surrounding the affected area, such as enlarged lymph nodes.
Dermoscopy: Dermoscopy involves using a special microscope to examine the skin and hair follicles in detail. This can help identify any characteristic features of tufted folliculitis, such as hair shaft abnormalities.
Trichoscopy: Trichoscopy involves using a special microscope to examine the scalp and hair follicles in detail. This can help identify any characteristic features of tufted folliculitis, such as hair shaft abnormalities.
Skin scrapings: Skin scrapings involve removing a small sample of skin from the affected area for examination under a microscope. This can help identify any signs of infection or inflammation.
Skin prick allergy tests: Skin prick allergy tests involve pricking the skin with a small amount of an allergen to see if an allergic reaction occurs.

Treatment

Possible treatments, along with an explanation of each treatment and its potential benefits and drawbacks.

Topical corticosteroids: Topical corticosteroids are often the first-line treatment for tufted folliculitis. They are applied directly to the affected areas of the scalp and can help reduce inflammation and itching. However, long-term use of topical corticosteroids can cause thinning of the skin and other side effects.
Topical calcineurin inhibitors: Topical calcineurin inhibitors are another type of topical medication that can be used to treat tufted folliculitis. They work by suppressing the immune response in the affected area, which can help reduce inflammation. However, there is a risk of skin cancer associated with long-term use of these medications.
Antibiotics: Antibiotics may be prescribed if there is evidence of a bacterial infection associated with tufted folliculitis. Oral antibiotics such as doxycycline or tetracycline may be used to treat the infection, while topical antibiotics such as mupirocin may be applied directly to the affected area.
Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be used to help reduce inflammation and relieve pain associated with tufted folliculitis.
Antifungal medications: Antifungal medications may be prescribed if there is evidence of a fungal infection associated with tufted folliculitis. These medications work by killing the fungi responsible for the infection.
Coal tar: Coal tar is a topical medication that can be used to treat a variety of skin conditions, including tufted folliculitis. It works by reducing inflammation and slowing the growth of skin cells. However, coal tar can be messy and have a strong odor.
Salicylic acid: Salicylic acid is a topical medication that can be used to help exfoliate the skin and reduce inflammation. It can be applied directly to the affected areas of the scalp.
Zinc pyrithione: Zinc pyrithione is an antifungal and antibacterial agent that can be used to help reduce inflammation and relieve symptoms of tufted folliculitis.
Phototherapy: Phototherapy involves exposing the scalp to UV light in order to help reduce inflammation and promote healing. However, there is a risk of skin cancer associated with long-term use of this treatment.
Laser therapy: Laser therapy involves using a high-energy beam of light to target and destroy the hair follicles responsible for tufted folliculitis. However, this treatment can be expensive and may require multiple sessions to achieve the desired results.
Cryotherapy: Cryotherapy involves using freezing temperatures to destroy the hair follicles responsible for tufted folliculitis. This treatment can be effective, but it can also be painful and may require multiple sessions.
Topical retinoids: Topical retinoids are a type of medication that can be used to help reduce inflammation and promote healing. However, they can cause skin irritation and other side effects.
Oral retinoids: Oral retinoids may be prescribed in severe cases of tufted folliculitis. They work by reducing inflammation and regulating the growth of skin cells.
Topical immunomodulators: Topical immunomodulators such as tacrolimus and pimecrolimus are used to reduce inflammation associated with tufted folliculitis.
Systemic immunosuppressants: Systemic immunosuppressants such as methotrexate and azathioprine can be used to treat severe cases of tufted folliculitis. They work by suppressing the immune system, which can reduce inflammation and improve the appearance of the skin.
Chemical peels: Chemical peels involve applying a chemical solution to the affected area to exfoliate the skin and improve its appearance.
Microdermabrasion: Microdermabrasion involves using a special device to exfoliate the skin and improve its appearance.
Ultrasound therapy: Ultrasound therapy involves using high-frequency sound waves to stimulate collagen production and improve the appearance of the skin.
Platelet-rich plasma therapy: Platelet-rich plasma therapy involves injecting a concentrated solution of platelets from the patient’s own blood into the affected area to stimulate healing and improve the appearance of the skin.
Botulinum toxin injections: Botulinum toxin injections can help reduce the appearance of scars associated with tufted folliculitis.

References