Folliculitis refers to a purulent inflammation caused by staphylococcus invading the hair follicle. In Chinese medicine, it is named differently based on the location and shape of the lesion, such as "large pearl sore," "hairline boil" (multiple folliculitis of the nape), "goat beard sore," "mole cricket boil" (folliculitis abscedens et suffodiens), "mole cricket gryllotalpa sore," or "eel head sore," among others. This condition commonly occurs on the head, nape, buttocks, perianal area, or other parts of the body, with a tendency to recur. It often appears in multiple locations, is stubborn in nature, and difficult to cure.

bubble_chart Pathological Changes

Traditional Chinese medicine believes that this disease is mostly caused by internal accumulation of dampness-heat, external exposure to pathogenic heat, which fumigates the lung system, accumulates in the skin, stagnates and transforms into heat over time. When the heat becomes excessive, it rots the flesh and forms pus. The pus toxin spreads and interconnects, leading to the onset of the disease. Alternatively, it may be due to constitutional weakness, failure of the defensive qi to consolidate, leading to external contraction of heat toxin; or due to unclean skin, further aggravated by invasion of wind toxin, resulting from the binding of wind and external pathogens.

Modern medicine holds that the pathogen of this disease is staphylococcus, primarily occurring in individuals with weakened immunity or diabetes patients. It is often caused by scratching, skin damage, and opportunistic invasion of hair follicles by pathogens, leading to inflammation. It may also be related to occupation or certain therapeutic factors. Frequent exposure to tar-like substances, long-term use of tar-like substances or corticosteroid drugs, as well as constant skin friction and other irritations, are all predisposing factors for this disease.

The rash initially appears at the hair follicle opening, presenting as itchy red follicular papules ranging from pinhead to mung bean size. The papules develop a small yellow-white pustule at the apex, surrounded by an inflammatory halo, with a hair follicle penetrating the center. The papules are numerous, scattered, and do not merge, accompanied by grade I pain and significant cutaneous pruritus. Generally, there are no systemic symptoms. After a few days, the pustules rupture, discharging a small amount of pus, and gradually heal. If the condition recurs and persists for several weeks, it may progress to chronic folliculitis. It commonly occurs in hairy areas such as the scalp, perineum, armpits, perianal region, and extensor surfaces of the limbs. The rash often follows conditions like seborrheic dermatitis, neurodermatitis, or cutaneous pruritus.

bubble_chart Treatment Measures

(1) Chinese Medicine Treatment

1. Internal Treatment: In the initial stage [first stage], it is advisable to clear heat and remove toxin, using the Five-Ingredient Toxin-Eliminating Decoction. If the patient exhibits scattered light red papules and small pustules on the body surface, accompanied by itching and pain, a red tongue texture, thick and greasy tongue coating, and other signs of exuberant dampness-heat, the treatment should focus on clearing heat, removing toxin, and draining dampness, using the Jin Yi Decoction. If the patient has a constitutionally weak body, a prolonged course of illness, and presents with a pale yellow complexion, poor appetite, a pale tongue texture, thin white tongue coating, deep and thin pulse, and other signs of deficiency of both qi and yin, the treatment should aim to replenish qi, nourish yin, clear heat, and remove toxin, using the Lan Qi Decoction.

⑴ Herbal Application: Select 1-2 types of fresh herbs such as dandelion, violet, hibiscus leaf, Purslane Herb, or Jin Bu Huan, mash them into a paste, and apply externally to the affected area, 1-2 times daily.

⑵ Two-Ingredient Toxin-Removing Plaster: Apply Coptis Rhizome ointment or As Wish Golden Yellow Powder mixed with honey as a paste externally, 1-2 times daily.

(2) Western Medicine Treatment:

1. Internal Treatment:

⑴ Oral administration of tetracycline, midecamycin, or intramuscular injection of penicillin, along with vitamin B supplements. For recurrent cases, intramuscular injection of placental globulin can be given twice within three weeks.

⑵ Immunotherapy: For patients with recurrent chronic folliculitis, autogenous or polyvalent bacterial vaccines can be used for injection therapy.

2. External Treatment: Based on the principles of anti-inflammatory, antibacterial, and drying effects, the following topical medications can be selected as appropriate: 10% sulfur calamine lotion, 10% ichthammol alcohol, compound neomycin ointment, 5% white precipitate mercury ointment, or chloramphenicol sulfoxide agent for external application.

3. Physical Therapy: Except during the acute inflammatory phase, ultraviolet or ultrashort wave radiation therapy can be administered for 20 minutes each time, three times per week.