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Systemic antibiotics may be tried if the skin infection is resistant to local treatment, if it is extensive or severe and accompanied by a febrile reaction, if it is complicated, or if it involves the nose or upper lip Extended periods of treatment (4 8 weeks or more) with antistaphylococcal antibiotics are required in some cases Hot tub pseudomonas folliculitis virtually always resolves without treatment but may be treated in adults with ciprofloxacin, 500 mg twice daily for 5 days Gram-negative folliculitis in acne patients may be treated with isotretinoin in compliance with all precautions discussed above (see Acne Vulgaris) Folliculitis due to M furfur is treated with topical 25% selenium sulfide, 15 minutes daily for 3 weeks, or with oral ketoconazole, 200 mg daily for 7 14 days Eosinophilic folliculitis may be treated initially by the combination of potent topical corticosteroids and oral antihistamines In more severe cases, treatment is with one of the following: topical permethrin (application for 12 hours every other night for 6 weeks); itraconazole, 200 400 mg daily; UVB or PUVA phototherapy; or isotretinoin, 05 mg/kg/d for up to 5 months A remission may be induced by some of these therapies, but chronic treatment may be required

Folliculitis on the back that looks like acne but does not respond to acne therapy may be caused by the yeast M furfur Biopsy may be required for diagnosis Steroid acne may be seen during topical or systemic corticosteroid therapy A form of sterile folliculitis called eosinophilic folliculitis consisting of urticarial papules with prominent eosinophilic infiltration is common in patients with AIDS It may appear first with institution of highly active antiretroviral therapy (HAART) and be mistaken for a drug eruption Pseudofolliculitis is caused by ingrowing hairs in the beard area In this entity, the papules and pustules are located at the side of and not in follicles It may be treated by growing a beard, by using chemical depilatories, or by shaving with a foil-guard razor Laser hair removal is dramatically beneficial in patients with pseudofolliculitis, requires limited maintenance, and can be done on patients of any skin color Pseudofolliculitis is a true medical indication for such a procedure and should not be considered cosmetic

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The symptoms range from slight burning and tenderness to intense itching The lesions consist of pustules of hair follicles

It is important to differentiate bacterial from nonbacterial folliculitis The history is important for pinpointing the causes of nonbacterial folliculitis, and a Gram stain and culture are indispensable One must differentiate folliculitis from acne vulgaris or pustular miliaria (heat rash) and from infections of the skin such as impetigo or fungal infections Pseudomonas folliculitis is often suggested by the history of hot tub use Eosinophilic folliculitis in AIDS often requires biopsy for diagnosis

Bacterial folliculitis is occasionally stubborn and persistent, requiring prolonged or intermittent courses of antibiotics Corticosteroid folliculitis is treatable by acne therapy and resolves as corticosteroids are discontinued

Rajendran PM et al Eosinophilic folliculitis: before and after the introduction of antiretroviral therapy Arch Dermatol 2005 Oct;141(10):1227 31 [PMID: 16230559]

Often follows an upper respiratory infection May present with chest pain (pleuritic or nonspecific) or signs of heart failure ECG may show sinus tachycardia, other arrhythmias, nonspecific repolarization changes, and intraventricular conduction abnormalities Echocardiogram documents cardiomegaly and contractile dysfunction Myocardial biopsy, though not sensitive, may reveal a characteristic inflammatory pattern

3:

Giant cell myocarditis is a rare idiopathic disorder characterized by giant cell and lymphocyte infiltration of the heart muscle Patients usually die of ventricular arrhythmias or heart failure but occasionally respond to immunosuppressive therapy or early transplantation

Cardiac dysfunction due to primary myocarditis is presumed to be caused by either an acute viral infection or a postviral immune response Secondary myocarditis is the result of inflammation caused by nonviral pathogens, drugs, chemicals, physical agents, or inflammatory diseases such as systemic lupus erythematosus The list of infectious causes of myocarditis is extensive and includes viruses with DNA and RNA cores The coxsackie virus is the predominant agent, but many others have been implicated Rickettsial myocarditis occurs with scrub typhus, Rocky Mountain spotted fever, and Q fever Diphtheritic myocarditis is caused by the exotoxin and is often manifested by conduction abnormalities as well as heart failure Chagas disease, caused by the insect-borne protozoan Trypanosoma cruzi, is a common form of myocarditis in Central and South America; the major clinical manifestations appear after a latent period of more than a decade At this stage, patients present with cardiomyopathy, conduction disturbances, and sudden death Associated gastrointestinal involvement (megaesophagus and megacolon) is the rule Toxoplasmosis causes myocarditis that is usually asymptomatic but can lead to heart failure Among parasitic infections, trichinosis is the most common cause of cardiac involvement The potential for the HIV virus to cause myocarditis is now well recognized, though the prevalence of this complication is not known and it appears related to the level of viral load and CD4 count In addition, other infectious causes of myocarditis are more common in patients with AIDS A complete list of infectious causes of myocarditis is shown in Table 10 11

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