Folliculitis in Darker Skin: Diagnosis and Management

00:01 How do we make a diagnosis of folliculitis? Clinical history and physical examination findings assist us . If you do a pus swab and look for grab a gram stain showing staph colonies which stain blue, and you do this by sending it to microbiologists and they do a gram stain and Standard culture.

00:26 The differential diagnosis of folliculitis includes acne in acne vulgaris. We have presence of comedones and lack of pruritis, and these are more consistent with acne vulgaris than folliculitis.

00:41 The second differential is pseudofolliculitis barbae, especially on the face, and this is caused by ingrown hair, which usually occurs after shaving.

00:51 We normally advise patients not to shave, clean and leave about three millimeters of hair above the skin surface, and in this condition, usually the culture is negative because it's an aseptic pustule. So how do we manage folliculitis? It's usually self-limiting and no treatment is needed.

01:14 Also, if you avoid the triggering factors, As one is able to eliminate folliculitis. There are, of course, indications for antibiotic treatment. For example, extensive disease like the picture that I showed you, where you have numerous papules or pustules or involvement of more than one body area. If one is persistent disease not resolving spontaneously within several weeks, then again, this is justifiable to give systemic antibiotics. The first line of treatment would be topical antibiotics, and the following are the topical antibiotics that we use in pitocin and fusidic acid, particularly in increasing resistance of staph aureus. Oral antibiotics if folliculitis fails to resolve or recurs after topical treatment, or in case of folliculitis bubble.

02:12 The following are the systemic antibiotics that we use, and these are used for various durations depending on the extent of the disease and the location.