CITW 5: A Close Shave

Welcome back to another Clinical Image of the Week from the case files of the Brown EM Residency!

HPI: 20 y/o otherwise healthy male presents to the ED with a rash on his neck. He states he woke up with the rash. It burns, but is not pruritic. He’s never had it before. He endorses some chills, but no fevers.  He states these lesions all appeared in areas where he had been shaved yesterday at the Barber Shop.

Vitals: BP 132/76, HR 67, T 98.9 °F, RR 12, SpO2 99 % on RA

Notable exam findings: See below

PF 1

PF 2

What’s the diagnosis?

Pustular Folliculitis

Here are some quick facts:

  • Folliculitis is an infection of the superficial hair follicles, and is typically found as small, erythematous, raised lesions, with a pustular center.
  • Folliculitis that is found in areas of repeated shaving is called folliculitis barbae.
  • Although typically caused by staph aureus, think of pseudomonas in patient’s exposed to poorly chlorinated hot tubs or whirpools.
  • More rarely, consider candidal folliculitis in patients who are immunosuppressed or on broad spectrum antibiotics.

How is this managed:

  • Treatment is typically conservative (warm compresses,), although topical antibiotics (mupirocin) can be considered as well.

Case Conclusion:

Patient was sent home with topical antibiotics and did well. He followed up in the dermatology clinic.

Shout out to Dr. McGregor for this case!

The contents of this case were deliberately altered to protect the identity of the patient. All content in this report are for educational purposes only. The patient consented to the use of these images.

See you next week!

Source: UptoDate

One thought on “CITW 5: A Close Shave

  1. Great images! The only thing I would add is that it’s important to instruct the patient not to shave until the lesions are cleared up, or they risk spreading the infection further. I once had a female patient who could not keep herself from shaving her legs before the lesions were cleared (actually multiple times) and wound up with a horrible refractory case needing prolonged oral antibiotics.

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