Folliculitis or Hidradenitis Suppurativa

Folliculitis is an infection of the hair follicle. Each hair on the body grows out of a tiny pore-like indention in the skin called a follicle. Folliculitis can be found on any part of the body that has hair, but it is most common on the face, scalp, and areas rubbed by clothing, such as the thighs and groin.

Folliculitis is usually caused by bacteria, especially the type called staph (Staphlococcus). However, it can also be caused by yeast and other types of fungi. Folliculitis caused by a fungus is most often seen in people who have an impaired immune system.

Often folliculitis develops because of damaged hair follicles. Shaving or wearing clothes that rub the skin can irritate the follicles. They can also become blocked or irritated by substances like makeup, sweat or oils. Once the follicles are injured, they are more likely to become infected.

Folliculitis usually looks like red pimples with a hair in the center of each one. The pimples can itch or burn or have pus in them. Mild folliculitis usually heals on its own in about two weeks. There are over-the-counter creams that can help relieve itching and aid in healing. If the infection does not go away, an antibiotic or antifungal cream will usually clear up the condition. However, if the folliculitis does not go away with treatment or breakouts continue to reoccur, especially if the look like boils, this could be hidradenitis suppurativa (HS). HS is also known as acne inversa.

Hidradenitis suppurativa is a chronic skin condition that begins as pimple-like lumps or pea-sized to marble-sized lumps under the skin. It commonly occurs around hair follicles, such as underarms, groin, under breasts or between the buttocks. HS can affect single or multiple areas on the body. The lumps can be painful. If they break open and drain pus, the pus is often foul smelling.

HS affects at least one percent of the population. Factors that may increase the risk for having HS may include age (commonly occurs in young adults), women are more likely to develop HS than are man and it can be inherited.

HS can cause scarring, pitting or pigmented patches of skin. Open sores and scar tissue may cause limited or painful movement, especially when the disease affects the underarms or thighs.

The lumps and bumps can change. One week it is leaking four smelling pus from breakouts. The next week, the breakouts have cleared, and scars are the only thing left on the skin.

A dermatologist should be consulted if the pimples, lumps or bumps leaking fluid do not go away in a reasonable amount of time. A dermatologist should be consulted, and treatments should be followed.

The dermatologist may use one or several of the treatments listed below:

• Antibiotics; helps fight infection.
• Acne washes and medicines
• Bleach bath
• Biologics: these medicines work on the immune system. Some biologics require self-injections; others require an infusion at the hospital or clinic.
• Corticosteroid: oral pills or an injection into the breakout.
• Diabetes drug, metformin may help
• Hormone therapy: some women who have HS get relief by taking birth control pills, spironolactone, or any other medication that regulates hormones. These medications can help reduce the pain and the amount of draining fluid.
• Other treatments may include methotrexate, oral retinoid or surgery.
• Wearing loose fitting clothing can reduce the friction.

Pilonidal Cyst

Pilonidal disease is a type of skin infection which typically occurs as a cyst between the cheeks of the buttocks and often at the upper end. Pilonidal cysts are itchy and often very painful, and typically occur between the ages of 15 and 35. Although usually found near the coccyx, the condition can also affect the navel, armpit or genital region, though these locations are much rarer.

Symptoms: Pain, swelling, redness, drainage of fluids from the cyst.

Usual onset: Young adulthood.

Risk factors: Obesity, family history, prolonged sitting, greater amounts of hair, not enough exercise.

Prevention: Shaving the area.

Treatment: Incision and drainage, electrolysis.

Frequency: 3 per 10,000 per year. It occurs more often in males than females.

The lesions may contain hair and skin debris. Diagnosis is based on symptoms and examination.

Signs and symptoms may include:

• Intermittent pain/discomfort or swelling above the anus or near the tailbone
• Opaque yellow (pus) or bloody discharge from the tailbone area
• Unexpected moisture in the tailbone region
• Discomfort sitting on the tailbone, doing sit-ups or riding a bicycle—any activities that roll over the tailbone area

Pilonidal sinus

Pilonidal sinus (PNS) is a sinus tract, or small channel, that may originate from the source of infection and open to the surface of the skin. Material from the cyst drains through the pilonidal sinus. A pilonidal cyst is usually painful, but with draining the patient might not feel pain.

Causes

One proposed cause of pilonidal cysts is ingrown hair. Excessive sitting is thought to predispose people to the condition, as sitting increases pressure on the coccygeal region. Trauma is not believed to cause a pilonidal cyst; however, such an event may result in inflammation of an existing cyst; there are cases where this can occur months after a localized injury to the area. Some researchers have proposed that pilonidal cysts may be caused by a congenital pilonidal dimple. Excessive sweating can also contribute to the formation of a pilonidal cyst: moisture can fill a stretched hair follicle, which helps create a low-oxygen environment that promotes the growth of anaerobic bacteria, often found in pilonidal cysts. The presence of bacteria and low oxygen levels hamper wound healing and exacerbate a forming pilonidal cyst.

Treatment

If there is infection, treatment is generally by incision and drainage of the cyst. The most commonly performed surgery is for the pilonidal sinus complex to be surgically excised with the wound often left open to heal. Post-surgical wound packing may be necessary and packing typically must be replaced daily for 4 to 8 weeks. In some cases, two years may be required for complete healing to occur.

If there is a recurrence of the cyst and / or surgery is not preferred, electrolysis is a viable option to treat and kill the hair formed in the infected follicle.

Trichotillomania (TTM)

A mental disorder which presents as a repeated and uncontrollable urge to pull out body hair. Trichotillomania is usually confined to one or two sites but can involve multiple areas. The scalp is the most common pulling site, followed by the eyebrows, eyelashes, face, arms, and legs. People who suffer from trichotillomania often pull only one hair at a time and these hair-pulling episodes can last for hours. 2.5 million people in the U.S. may have trichotillomania at some time during their lifetimes.

Symptoms include:

• Repeated hair pulling
• Feeling tense before pulling hair
• Feeling relieved after pulling hair
• Distress due to hair pulling
• Bare patches on areas where hair has been pulled
• Abnormal behavior such as chewing on or eating hair

Physicians and scientists believe a combination of factors contribute to the underlying causes of trichotillomania:

• Genetic factors – many people with the disorder have a direct relative that suffered with the disorder.
• Environment - Sedentary activities such as being in a relaxed environment are conducive to hair pulling.

Complications may include:

• Emotional distress Many people with trichotillomania report feeling stress, anxiety, shame, embarrassment, frustration or depression. Obsessive-compulsive disorder is common with TTM sufferers.
• Problems with social and work functioning. They worry about what others might think or say. People with TTM often have low self-esteem.
• Skin and hair damage. Constant hair pulling can cause scarring and hair damage.
• Hairballs. Eating your hair may lead to a large, matted hairball (trichobezoar).

Trichotillomania typically begins between ages 9 to 13, though it can start before or after this period. When treating youth, clinicians emphasize the importance of using positive reinforcement. Praise tends to work much better than scolding or shaming.

A therapist may also help people with trichotillomania learn to manage stress, deal with perfectionism, or work out other compulsive habits they may have, like nail biting.

Even though there is no cure for trichotillomania, people that suffer from hair pulling can take comfort in knowing that there are several things they can do to work through the disorder. Most people needing treatment for trichotillomania will respond best to a combination of behavioral therapy and medications (often anti-depressants). A relapse into hair pulling is not unusual, even after therapy.

How to Deal With Trichotillomania at Home:

• Acknowledging and Understanding. The first step in recovering from any psychological disorder is to acknowledge and understand the problem.
• Practicing Impulse Control.
• Habit reversal training (HRT) has the highest rate of success in treating trichotillomania.
• Provide Stimulation.
• Protect the Hair.
• Create Distractions.