Folliculitis

Folliculitis is defined histologically as the presence of inflammatory cells within the wall and ostia of the hair follicle, creating a follicular-based pustule. The actual type of inflammatory cells can vary and may be dependent on the etiology of the folliculitis, the stage at which the biopsy specimen was obtained, or both. The inflammation can be either limited to the superficial aspect of the follicle with primary involvement of the infundibulum or the inflammation can affect both the superficial and deep aspect of the follicle. Deep folliculitis can eventuate from chronic lesions of superficial folliculitis or from lesions that are manipulated, and this may ultimately result in scarring.

Perifolliculitis, on the other hand, is defined as the presence of inflammatory cells in the perifollicular tissues and can involve the adjacent reticular dermis. Folliculitis and perifolliculitis can manifest independently or together as a result of follicular disruption and irritation.

Acne represents a noninfectious form of folliculitis. The follicular inflammation seen in acne occurs as a secondary event as a result of follicular obstruction from abnormal keratinization. In acne, the superficial aspect of the follicle distends and is obstructed by a keratin plug. The sebum fills the follicle, and the normally commensal bacteria (Propionibacterium acnes) produces excess free fatty acids, which trigger follicular inflammation.

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Case Review in Adolescent Acne: Multifactorial Considerations to Optimizing Management

The management of pediatric and adolescent acne requires multifaceted considerations revolving around the patient, parents, and appropriate treatment. The following case report represents a typical scenario exemplifying the key role of the dermatology nurse practitioner in optimizing successful acne management outcomes.

Acne vulgaris is common among adolescents; most, if not all, personally experience its impact or are directly involved with individuals who have the condition. Effects of acne may extend beyond the physical lesions; psychological and social implications associated with the condition can be equally severe. The management of acne is multifactorial and, fortunately, a number of therapeutic options are available. Nevertheless, careful consideration must be made, particularly among adolescents, to properly align appropriate treatment to optimize outcomes.

The role of nurse practitioners (NP) is particularly important, as the need for continual patient education, motivation, and followup can sometimes lapse in a typically busy clinical practice. Addressing patient concerns, evaluating treatment efficacy and tolerability, and monitoring adherence to treatment are critical components of acne management. The following case study represents a characteristic scenario where all of the aforementioned components play a considerable role in the NP's contributions to successful management.

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Acne Vulgaris

 


Acne vulgaris is a common skin disease that affects 60-70% of Americans at some time during their lives. Twenty percent will have severe acne, which results in permanent physical and mental scarring. Acne vulgaris is American's most common diseas and is characterized by noninflammatory, open or closed comedones and by inflammatory papules, pustules, and nodules. Acne vulgaris affects the areas of skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back.

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