eMedicine Specialties > Dermatology > Bacterial Infections

Pseudomonas Folliculitis: Differential Diagnoses & Workup

Author: Charles B Toner, MD, Assistant Professor, Department of Dermatology, Uniformed Services University of the Health Sciences; Mohs Micrographic Surgeon, Consultant, Charles County Dermatology, Maryland, and Georgia Dermatology & Skin Cancer Center
Coauthor(s): Stephen J Krivda, MD, Assistant Professor of Dermatology, Uniformed Services University of the Health Sciences; Chief of the Integrated Department of Dermatology, Chief of Dermatology Service, Director of Dermatopathology, Staff Dermatopathologist, Walter Reed Army Medical Center; Head, Department of Dermatology, Staff Dermatologist and Dermatopathologist, National Naval Medical
Contributor Information and Disclosures

Updated: Jun 18, 2009

Differential Diagnoses

Contact Dermatitis, Irritant

Other Problems to Be Considered

Acne
Bromide sensitivity
Staphylococcal folliculitis
Gram-negative folliculitis

Workup

Laboratory Studies

  • The diagnosis of Pseudomonas folliculitis is best verified by results of bacterial culture growth from either a fresh pustule or a sample of contaminated water.
  • Gram stain of a Pseudomonas folliculitis pustule may also be performed.

Histologic Findings

Standard hematoxylin and eosin preparation displays a severe follicular epithelial inflammatory response, which may result in follicular distention and rupture. The pilar canal is filled with a dense polymorphonuclear leukocytic infiltrate, often accompanied by a brisk perifollicular lymphocytic infiltration. Both the epidermis and the infected apocrine glands remain intact.

More on Pseudomonas Folliculitis

Overview: Pseudomonas Folliculitis
Differential Diagnoses & Workup: Pseudomonas Folliculitis
Treatment & Medication: Pseudomonas Folliculitis
Follow-up: Pseudomonas Folliculitis
Multimedia: Pseudomonas Folliculitis
References
[ CLOSE WINDOW ]

References

  1. Gregory DW, Schaffner W. Pseudomonas infections associated with hot tubs and other environments. Infect Dis Clin North Am. Sep 1987;1(3):635-48. [Medline].

  2. Highsmith AK, Le PN, Khabbaz RF, Munn VP. Characteristics of Pseudomonas aeruginosa isolated from whirlpools and bathers. Infect Control. Oct 1985;6(10):407-12. [Medline].

  3. McCausland WJ. Pseudomonas aeruginosa rash associated with whirlpool. JAMA. Nov 29 1976;236(22):2490-1. [Medline].

  4. Price D, Ahearn DG. Incidence and persistence of Pseudomonas aeruginosa in whirlpools. J Clin Microbiol. Sep 1988;26(9):1650-4. [Medline].

  5. Ratnam S, Hogan K, March SB, Butler RW. Whirlpool-associated folliculitis caused by Pseudomonas aeruginosa: report of an outbreak and review. J Clin Microbiol. Mar 1986;23(3):655-9. [Medline].

  6. Rose HD, Franson TR, Sheth NK, Chusid MJ, Macher AM, Zeirdt CH. Pseudomonas pneumonia associated with use of a home whirlpool spa. JAMA. Oct 21 1983;250(15):2027-9. [Medline].

  7. Jacobson JA. Pool-associated Pseudomonas aeruginosa dermatitis and other bathing-associated infections. Infect Control. Oct 1985;6(10):398-401. [Medline].

  8. Lacour JP, el Baze P, Castanet J, Dubois D, Poudenx M, Ortonne JP. Diving suit dermatitis caused by Pseudomonas aeruginosa: two cases. J Am Acad Dermatol. Dec 1994;31(6):1055-6. [Medline].

  9. Saltzer KR, Schutzer PJ, Weinberg JM, Tangoren IA, Spiers EM. Diving suit dermatitis: a manifestation of Pseudomonas folliculitis. Cutis. May 1997;59(5):245-6. [Medline].

  10. Bottone EJ, Perez AA 2nd, Oeser JL. Loofah sponges as reservoirs and vehicles in the transmission of potentially pathogenic bacterial species to human skin. J Clin Microbiol. Feb 1994;32(2):469-72. [Medline].

  11. Frenkel LM. Pseudomonas folliculitis from sponges promoted as beauty aids. J Clin Microbiol. Oct 1993;31(10):2838. [Medline].

  12. Maniatis AN, Karkavitsas C, Maniatis NA, Tsiftsakis E, Genimata V, Legakis NJ. Pseudomonas aeruginosa folliculitis due to non-O:11 serogroups: acquisition through use of contaminated synthetic sponges. Clin Infect Dis. Aug 1995;21(2):437-9. [Medline].

  13. Böni R, Nehrhoff B. Treatment of gram-negative folliculitis in patients with acne. Am J Clin Dermatol. 2003;4(4):273-6. [Medline].

  14. Berger RS, Seifert MR. Whirlpool folliculitis: a review of its cause, treatment, and prevention. Cutis. Feb 1990;45(2):97-8. [Medline].

  15. Agger WA, Mardan A. Pseudomonas aeruginosa infections of intact skin. Clin Infect Dis. Feb 1995;20(2):302-8. [Medline].

  16. Ratnam S, Hogan K, March SB, Butler RW. Whirlpool-associated folliculitis caused by Pseudomonas aeruginosa: report of an outbreak and review. J Clin Microbiol. Mar 1986;23(3):655-9. [Medline].

  17. Evans MR, Wilkinson EJ, Jones R, Mathias K, Lenartowicz P. Presumed Pseudomonas folliculitis outbreak in children following an outdoor games event. Commun Dis Public Health. Apr 2003;6(1):18-21. [Medline].

  18. Fox AB, Hambrick GW Jr. Recreationally associated Pseudomonas aeruginosa folliculitis. Report of an epidemic. Arch Dermatol. Oct 1984;120(10):1304-7. [Medline].

  19. Yu Y, Cheng AS, Wang L, Dunne WM, Bayliss SJ. Hot tub folliculitis or hot hand-foot syndrome caused by Pseudomonas aeruginosa. J Am Acad Dermatol. Oct 2007;57(4):596-600. [Medline].

  20. Gustafson TL, Band JD, Hutcheson RH Jr, Schaffner W. Pseudomonas folliculitis: an outbreak and review. Rev Infect Dis. Jan-Feb 1983;5(1):1-8. [Medline].

  21. Malterud K, Thesen J. [Whirlpool and pseudomonas infection--a local outbreak]. Tidsskr Nor Laegeforen. Jun 28 2007;127(13):1779-81. [Medline].

  22. MMWR. An outbreak of Pseudomonas folliculitis associated with a waterslide--Utah. MMWR Morb Mortal Wkly Rep. Aug 19 1983;32(32):425-7. [Medline].

  23. Tate D, Mawer S, Newton A. Outbreak of Pseudomonas aeruginosa folliculitis associated with a swimming pool inflatable. Epidemiol Infect. Apr 2003;130(2):187-92. [Medline].

  24. Chiller K, Selkin BA, Murakawa GJ. Skin microflora and bacterial infections of the skin. J Investig Dermatol Symp Proc. Dec 2001;6(3):170-4. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Pseudomonas folliculitis, pseudomonal folliculitis Pseudomonas aeruginosa folliculitis, whirlpool folliculitis, spa pool folliculitis, hot tub folliculitis, gram-negative folliculitis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Charles B Toner, MD, Assistant Professor, Department of Dermatology, Uniformed Services University of the Health Sciences; Mohs Micrographic Surgeon, Consultant, Charles County Dermatology, Maryland, and Georgia Dermatology & Skin Cancer Center
Charles B Toner, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Medical Association, American Society for Dermatologic Surgery, Association of Military Dermatologists, and Association of Military Surgeons of the US
Disclosure: Nothing to disclose.

Coauthor(s)

Stephen J Krivda, MD, Assistant Professor of Dermatology, Uniformed Services University of the Health Sciences; Chief of the Integrated Department of Dermatology, Chief of Dermatology Service, Director of Dermatopathology, Staff Dermatopathologist, Walter Reed Army Medical Center; Head, Department of Dermatology, Staff Dermatologist and Dermatopathologist, National Naval Medical
Stephen J Krivda, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Leonard Sperling, MD, Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences
Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory
Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.