Internal Medicine

0521779407-07 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Folic Acid/Cobalamin (Vitamin B12) Deficiency Folliculitis and Furunculosis 581

➣Gram-negative folliculitis occurs following exposure to a poorly

cleaned or chlorinated pool

➣Poor hygiene

➣Staphylococcus and streptococcus are the most common bacte-

rial causes.

➣Recent hot tub use is associated with Pseudomonas infection and

is self-limited.

Signs & Symptoms

■Itching, tenderness, purulent drainage, possibly fever

■Follicularly based pustules (folliculitis)

■Hot tub folliculitis – usually follicular pustules on the back

■A furuncle is a red tender nodule(s).

■A carbuncle is often larger, multilocular and studded with pustules;

associated with fever, malaise, and leukocytosis.

tests

■Complete blood count

■Gram stain of the exudates or contents

■Cultures are not always necessary.

■Blood sugar determination and/or HIV testing with recurrent disease

differential diagnosis

■Cutaneous candiasis

■Blastomycosis, cryptococcus or other deep fungi

■Inflammatory variant of a dermatophyte infection (Majocchi’s gran-

uloma)

■Acute febrile neutrophilic dermatosis (Sweet’s syndrome)

management

What to Do First

■Assess area involved.

■Check status of immune function.

General Measures

■Counsel regarding hygiene.

■Antibacterial soaps if the process is associated with a folliculitis

specific therapy

■Oral antibiotics with good coverage of Staphylococcus and Strepto-

coccus for furuncles or carbuncles

■Incision and drainage of fluctuant areas