There are several skin complications related to diabetes. Folliculitis is a bacterial or fungal infection of hair follicles that occurs in both diabetic and non-diabetic individuals. There are two forms of folliculitis, superficial and deep. Superficial folliculitis effects the upper hair follicle causing red or pus-filled bumps around the hair follicle resembling whiteheads, pus-filled blisters that rupture, inflamed skin, and itchiness or tenderness. Deep folliculitis affects the entire hair follicle with infection based in the cutis. Symptoms are large pus-filled blisters the rupture, a large swollen mass, pain, and possible scarring.
Diabetes: Folliculitis Bacterial Infections
Several strains of bacteria cause superficial folliculitis. The most common type is caused by Staphylococcus aureus (which lives on the skin) and can breakout anywhere on the body. Colloquially known as “barber’s itch” for men, women also may experience infection after shaving their legs, armpits, or bikini area. S. aureus can also enter the skin through cuts and other wounds. Pseudomonas folliculitis aptly called “hot tub folliculitis” usually comes into contact with people in hot tubs with poorly maintained chlorine and pH. The bacteria create a rash of red bumps that can form into pustules within eight hours or five days of exposure, becoming worse in areas of prolonged exposure, such as under a swimsuit. Particular to men, pseudofolliculitis barbae affects the hair follciles of the beard, causing them to curl into the skin. A second form common to men is caused by yeast and causes pustules on the back and chest.
Forms of deep folliculitis include sycosis barbae, which affects men when they begin shaving, causing inflammation, pustules, and can eventually cause scarring. Boils and carbuncles are severe infection of the hair follicle by staph bacteria. Boils are infection of a single hair follicle resulting in a swollen, pus-filled, red bump. Carbuncles are deep infections of several hair follicles and tend to develop on the shoulders, back, thighs, and neck. Carbuncles are more serious and can cause scarring and severe complications, often requiring a doctor for proper treatment. Boils generally will rupture and drain on their own, only requiring that the area be kept clean and covered.
Risks for Patients with Diabetes: Folliculitis and Glucose Levels
Lowered immune resistance related to both types of diabetes leaves patients more susceptible to the bacteria and fungi that cause folliculitis. Patients who do not have well regulated blood glucose and increase their risk of deep folliculitis infection and their ability to fight superficial infections as well, resulting in chronic folliculitis. Also linked to obesity, diabetic patients who are obese will benefit from weight loss as weight is related to diabetic complications in general.
