Perianal Dermatitis and Folliculitis
Perianal dermatitis is an inflammation of the skin around the anus, manifested by redness, swelling, soreness and itching. Perianal dermatitis can have a contact, allergic, bacterial or fungal nature, occur against the background of enterobiosis, inflammatory bowel disease, hemorrhoids, anal fissure. In the diagnosis of a disease, determining its etiology by microscopic examination and smear or scraping of the perianal area is of primary importance. The treatment is carried out in accordance with the established cause of perianal dermatitis.
Perianal dermatitis occurs in people of any age, from newborns to old people. In infants, it, like diaper dermatitis, is often associated with violation of the rules of care of the baby’s skin. In adults, perianal dermatitis often occurs against the background of the pathology of the large intestine and rectum, disorders of the intestinal microflora, and other diseases of the anal area. So, about 6.5% of patients with candidal dysbacteriosis of the intestine suffer from perianal dermatitis of candidal etiology. In connection with these diagnostics and treatment of perianal dermatitis, not only dermatology, but also proctology is involved.
Causes of Perianal Dermatitis
Perianal dermatitis can be caused by hygiene or irritation of the anal area. Dermatitis may be caused by prolonged diarrhea, a negative effect on the skin of synthetic underwear or detergent left on the laundry after washing. The incontinence of feces with the prolapse of the rectum or its tumor lesion can also cause perianal dermatitis.
In inflammatory diseases such as ulcerative colitis, Crohn's disease, colitis, proctitis, paraproctitis, the inflammatory process from the intestine can spread to the skin of the perianal area. The appearance of perianal dermatitis is possible with enterobiasis, dysbacteriosis, hemorrhoids. Damage to the skin in the anus (anal fissure, scratching during anal itching) contribute to its infection with the development of dermatitis of bacterial or fungal etiology.
There is an abscess fistula form of perianal dermatitis, which develops during long-term driving by car or riding due to the introduction of broken hair into the skin of the perianal area. This form is called the "jeep disease".
In the occurrence of perianal dermatitis, not the last role is played by the state of the microorganism. The tendency to allergic reactions contributes to the development of contact dermatitis of the anal area. Reduced immunity and barrier function of the skin leads to an easy penetration of infectious agents into it with the development of dermatitis, staphylo-streptococcal, candidal or other nature. Newborn and elderly people, patients with various immunodeficiency states, after long-term antibiotic therapy, treatment with corticosteroids, and HIV-infected people are prone to this mechanism of perianal dermatitis.
Symptoms of perianal dermatitis
The main manifestations common to all types of perianal dermatitis are inflammatory changes in the skin of the anal area: redness, soreness, swelling. Itching is often pronounced, aggravating the course of the disease due to constant trauma to the skin when combing.
Perianal dermatitis of bacterial genesis is characterized by the appearance of pustules and vesicles with purulent contents against the background of hyperemia. Such dermatitis may be accompanied by soakiness, erosion and the formation of crusts. For fungal dermatitis, the scalloped edges of the inflammation area, whitish plaque, peeling, the location of pustules and vesicles along the periphery of the inflammatory focus are typical. Allergic dermatitis is accompanied by severe itching, the formation of papules with serous contents, upon opening of which erosions occur.
Abscessing fistulous form of perianal dermatitis (jeep's disease), is manifested by small recurrent abscesses with the formation of short fistulous passages in the folds of the anus. In diseases of the intestine, manifestations of perianal dermatitis are combined with a violation of the stool (constipation, diarrhea), pain in the abdomen or rectum (proctalgia), secretions from the anus of the mucous, purulent or bloody nature.
Diagnosis of Perianal Dermatitis
Patients with inflammatory changes in the skin of the perianal area most often come to the consultation of a dermatologist or proctologist. The doctor conducts a survey aimed at identifying the symptoms and causes of the disease, as well as concomitant bowel disease. Inspection of the anal area allows you to determine not only the condition of the skin, but also to detect the presence of cracks, hemorrhoids, prolapse of the rectum.
To determine the etiology of perianal dermatitis, a scraping of pathogenic fungi is taken from the skin of the anal area, bacteriological examination of the detachable skin elements and smear from the anus is performed, scraping for enterobiasis and analysis of feces for dysbacteriosis are investigated. Diagnosis of concomitant diseases of the intestine is carried out using a coprogram, sigmoidoscopy, ultrasound, irrigoscopy, radiography with barium, colonoscopy.
Treatment of perianal dermatitis
Therapy of perianal dermatitis is effective only if it is carried out in accordance with its etiology. It is important to maintain the hygiene of the anal area, wearing cotton soft underwear that does not cause compression, friction or irritation of the affected area. To relieve itching, antihistamine medication is prescribed: loratadine, chloropyramine, clemensin, mebhydrolin.
Local treatment of perianal dermatitis is carried out with the use of dexpanthenol, ointments with zinc and antiseptics, baths with chamomile, string, oak bark. In case of bacterial damage, purulent pustules are opened and treated with solutions of aniline dyes (blue, brilliant green, fukartsin), antibacterial ointments are prescribed. Therapy of fungal dermatitis is carried out with local antifungal ointments.
When an enterobiasis is detected, anthelmintic drugs are treated: piperazine, pyrantel, mebendazole, albendazole, ornidazole. The presence of dysbiosis and other intestinal diseases is an indication for treatment by a gastroenterologist or proctologist.
Folliculitis - an infectious lesion of the middle and deep sections of the hair follicle, leading to its purulent inflammation. Folliculitis can have a bacterial, fungal, viral, parasitic etiology. It is manifested by the appearance in the areas of hair growth of single or multiple pustules, in the center of which the hair passes. Opened pustules form ulcers, their healing with a deep lesion of the hair follicle is accompanied by scarring. Diagnosis of folliculitis is carried out by dermatoscopy, smear microscopy and examination of detachable pustules. Treatment is carried out with solutions of aniline dyes, antiseptics, local and systemic use of etiotropic drugs: antibiotics, antimycotics, acyclovir.
Along with hydradenitis, sycosis, streptoderma and streptococcal impetigo-folliculitis refers to purulent skin diseases (pyoderma), whose prevalence among the population reaches 40%. In hot countries, the incidence of folliculitis is higher because the climate itself contributes to the development of infection. A high incidence rate is also noted among socially disadvantaged segments of the population living in unsanitary conditions.
In some cases, folliculitis begins with ostiofollikulit - superficial inflammation of the hair follicle, exciting only his mouth. Further spread of the infection to the depth of the follicle leads to the transformation of the ostiofolliculitis into the folliculitis.
Causes of folliculitis
Infectious agents that cause folliculitis, in most cases, are bacteria, mainly staphylococcus. There are folliculitis due to pseudomonads, the causative agent of syphilis, gonorrhea and other bacteria. The cause of the disease can be fungal skin lesions (fungi of the genus Candida and Pityrosporum, dermatophytes), viruses (molluscum contagiosum, simple and herpes zoster) and parasites (for example, tick causing demodicosis). In accordance with the etiology of the infectious process, clinical dermatology secretes bacterial, fungal, viral, syphilitic and parasitic folliculitis.
The penetration of the infection into the hair follicle occurs through minor skin damage: scratches, excoriation, abrasions, soak. The probability of infection is increased in people suffering from pruritic dermatoses (eczema, pruritus, atopic dermatitis, allergic contact dermatitis, Dühring dermatitis) and therefore constantly combing their skin, as well as in persons suffering from excessive sweating.
The weakening of the body's defenses and the barrier function of the skin facilitates the penetration of the infection inside the hair follicle and the development of folliculitis. Therefore, factors contributing to infection include diabetes mellitus and various immunodeficiencies: HIV infection, conditions associated with prolonged illness or immunosuppressive therapy. Prolonged percutaneous use of glucocorticosteroids leads to a decrease in local immunity and may also favor the development of folliculitis. Reducing the protective properties of the skin occurs with prolonged exposure to various chemicals: kerosene, lubricants, technical oils. The occurrence of a professional folliculitis in mechanics, tractor drivers, and oilmen is connected with these.
Symptoms of folliculitis
Folliculitis begins with redness and infiltration in the hair follicle area. Then, a conical pustule penetrated with downy hair with purulent contents in the center is formed. After its opening and release from pus, a small sore is formed, covered with a bloody-purulent crust. If the entire follicle is affected, hyperpigmentation or a scar remains on the skin after the skin is peeled. More superficial folliculitis may resolve, leaving no trace behind. The process of development and resolution of inflammation of one follicle takes up to 1 week.
Most often the folliculitis is multiple in nature. Its elements are usually located on the hairy areas of the skin: on the face, head, in the armpits, in the groin, on the legs (mainly in women depilating the legs and thighs). Rash accompanied by pain and itching of varying severity. In the absence of correct treatment and hygiene measures, folliculitis is complicated by the development of boils, carbuncles, hydradenitis, abscesses, and phlegmon.
Staphylococcal folliculitis is usually localized in areas of bristly hair growth, most often it is the chin and skin around the mouth. It occurs mainly in men who shave their beards and mustaches. May be complicated by the development of sycosis.
The pseudomonad folliculitis is popularly called “hot bath folliculitis”, because in most cases it occurs after taking a hot bath with insufficient chlorination of water. Often develops in patients undergoing antibiotic treatment for acne. Clinically expressed in a sharp increase in acne, the appearance on the face and upper body pierced with hair pustules.
Syphilitic folliculitis (acne syphilide) develops in secondary syphilis, accompanied by non-cicatrical alopecia in the growth zone of the beard and mustache, as well as the scalp.
Gonorrheal folliculitis is a complication of untreated and long-lasting gonorrhea. Favorite localization - the skin of the perineum in women and the foreskin in men.
Candida folliculitis is observed mainly when applying occlusive dressings, in bedridden patients and with prolonged fever.
Dermatophytic folliculitis is characterized by the onset of inflammatory changes from the surface stratum corneum of the epidermis. The process then gradually captures the follicle and hair shaft. May occur on the background of trichophytia and favus, leaving cicatricial changes.
Herpetic folliculitis is characterized by the formation of vesicles in the mouths of hair follicles. Observed on the skin of the chin and nasolabial triangle, often in men.
Folliculitis, caused by demodicosis, is manifested by reddening of the skin with the formation of characteristic pustules in the mouths of hair follicles, around which a scaly peeling is noted.
Impetigo Bockhart - another version of folliculitis. It develops with skin maceration. Most often occurs with hyperhidrosis or as a result of therapy with warming compresses.
Diagnosis of folliculitis
Diagnostic measures for suspected folliculitis are aimed at investigating the condition of the hair follicle; identification of the causative agent that caused inflammation; exclusion of a specific etiology of the disease (syphilis, gonorrhea); identification of associated diseases conducive to the development of the infectious process.
At a consultation with a dermatologist, an eruption and dermatoscopy examination is conducted, which helps the doctor determine the depth of the lesion of the follicle. Produced intake detachable pustules for microscopy and bacteriological seeding, research on fungi and pale treponema. To exclude gonorrhea and syphilis, PCR diagnostics and RPR testing are performed. If necessary, the patient is assigned an immunogram, a blood test for sugar and other examinations.
In the course of diagnostics, folliculitis is differentiated from ostiofolliculitis, frioderma, Hoffmann perifolliculitis, furunculosis, nodular cystic acne, streptococcal impetigo, pink lichen from Zhiber, drug-induced toxicoderma.
Folliculitis therapy should be consistent with its etiology. With bacterial genesis of folliculitis, ointments with antibiotics are prescribed, with fungal - antifungal drugs, treatment of herpes folliculitis is carried out with acyclovir.
At the beginning of the disease, local treatment and treatment of lesions with solutions of aniline dyes (fukartsin, zelenka, methylene blue) are sufficient. To prevent the spread of infection to healthy areas of the skin, they are treated with salicylic or boric alcohol. Additionally applied UFO.