Ostiofolliculitis (staphylococcal impetigo) is an inflammation of the upper part of the hair follicle or sebaceous gland caused by the penetration and reproduction of staphylococci in them. It is manifested by small single or multiple pustules, not prone to peripheral growth and fusion. Most often, ostiofolliculitis occurs on the skin of the neck, face, thighs, shins and forearms. Diagnosis is based on the clinical picture and dermatoscopy, to confirm the type of pathogen, the contents of the pustules are seeded. Treatment of ostiofolliculitis consists in the topical application of various antibacterial agents and UVI.
Ostiofolliculitis refers to pyoderma — purulent-inflammatory skin diseases. It occurs in any age group. But more often, pediatric dermatology encounters it in its practice. In children, ostiofolliculitis is observed, as a rule, on the skin of open areas, in places of abrasions, scratches, scratches and insect bites. In men, the skin in the beard and mustache area is often affected, while the superficial inflammation of individual follicles in the form of ostiofolliculitis is only the beginning of a more common process — sycosis.
The etiological factor of the occurrence of ostiofolliculitis is golden or white staphylococcus. Along with other representatives of the saprophytic microflora, staphylococci are present on the surface of the skin of a healthy person, without causing any inflammatory changes. Their penetration into the mouth of the sebaceous glands and follicles and increased reproduction there may be due to a decrease in immunity, which occurs after hypothermia, infection (tuberculosis, hepatitis, meningitis, severe forms of measles), against the background of frequent acute respiratory infections or long-term somatic disease (bronchitis, pneumonia, myocarditis, pyelonephritis, kidney failure, etc.). A decrease in the barrier function of the skin in diabetes mellitus can also cause staphylococcal impetigo.
The development of ostiofolliculitis is promoted by increased sweating, insufficient hygiene, increased skin pH, overheating, increased secretion by sebaceous glands, skin traumatization (friction, shaving, maceration). Ostiofolliculitis can occur if various harmful substances are regularly exposed to human skin during professional activity: gasoline, tar, lubricating oils, kerosene, etc.
Ostiofolliculitis begins with redness in the area of the outlet of the duct of the sebaceous gland or hair follicle. There is some soreness in this place, which increases with pressure. Then a pustule surrounded by an inflammatory corolla is formed — a cone-shaped formation up to 5 mm in size and with a yellow tip in which there is pus. There is a hair in the center of the pustule.
The formed pustule with ostiofolliculitis does not increase in diameter. It dries up quickly (in 3-5 days), a brown crust forms, which disappears, sometimes leaving behind a slight temporary hyperpigmentation. Without adequate treatment, the inflammatory process, which captures only the upper part of the follicle with ostiofolliculitis, can spread into its depth, leading to the development of deep folliculitis, after which small scars remain on the skin.
With ostiofolliculitis, the rashes are multiple in nature. Pustules can be located separately or in groups, forming separate foci of skin lesions. However, even if they are located side by side, they never merge with each other. The typical localization of ostiofolliculitis is the areas of the skin most susceptible to external influences and contamination: the face, neck, arms up to the elbows, lower legs and thighs.
In a separate clinical form of ostiofolliculitis, staphylococcal impetigo of Bockhart is isolated, in which there is an increase in pustules to the size of a pea and a fluffy hair passes in the center of each pustule. This type of ostiofolliculitis is localized on the skin of the back of the hands and is often a complication of scabies.
In men, and sometimes in women, the lesion of hair follicles in the growth zone of the mustache and beard is called sycosis. Less often there is inflammation of the follicles of the armpits and eyebrows. The disease begins as ostiofolliculitis, but has a recurrent character with the transition to folliculitis and the fusion of individual areas of the lesion into a single inflammatory focus.
If pustules appear on the skin, which are multiple in nature, it is better to immediately contact a dermatologist. A simple examination of the rashes and an examination of the elements under magnification (dermatoscopy) in most cases will be sufficient for the doctor to diagnose ostiofolliculitis. The conical shape of the pustules, the absence of infiltration around them and the presence of pus on the top of the elements indicate the superficial nature of inflammation and its staphylococcal nature.
Collecting anamnesis and determining the pH of the skin helps to identify the cause of ostiofolliculitis. To isolate the pathogen, a back-seeding of the separated pustules is prescribed, to exclude the generalization of the process, blood is seeded for sterility. Ostiofolliculitis must be differentiated with deep folliculitis, streptococcal impetigo, sweating, pseudofurunculosis.
Local antibacterial therapy of ostiofolliculitis is carried out with the use of antiseptics: calcium permanganate solution, diamond green, fucorcin, methylene blue and antibacterial ointments: tetracycline, heliomycin, colimycin, erythromycin. Local UVI therapy in suberythemic doses and laser therapy have a good antibacterial effect. With single elements of ostiofolliculitis, it is possible to open pustules and purify them from pus.
The recurrent nature of ostiofolliculitis may be an indication for general antibiotic therapy, taking into account the results of bacteriological studies. In the same cases, treatment aimed at improving immunity is carried out: ultraviolet (UV) and laser (VLOC) blood irradiation, autohemotherapy, general UVI therapy.
Prevention of the occurrence of ostiofolliculitis or its relapses consists in observing hygienic skin care, preventing its frequent injury, wearing protective equipment when working with harmful substances, timely correction of the decrease in the protective function of the immune system.