Folliculitis Responses

Folliculitis Responses

Dear Colleagues,
Thank you all for your responses. I also plan to speak with some
dermatologists and will eventually post that info as well.
My apologies for the time delay. I have been out of town.

I found this information from the book Skin Problems of the Amputee
by William Levy MD

Folliculitis, usually caused by staphylococci, is a superficial bacteria
infection of the hair follicle in which the primary lesion is an inflammatory
papule or pustule. It is a commonly encountered problem in the amputee,
particularly in dark complexioned, hairy persons with oily skin. The
condition is aggravated by the use of an artificial limb. It is usually worse
in the summer, when increased warmth and moisture from perspiration promote
maceration of the skin, which in turn favors invasion of the hair follicle by
bacteria. Ordinarily this process is not serious, but sometimes progresses to
boil formation, cellulitis, or an eczematous,weeping, and crusted superficial
pyoderma
The original post
<<I have a patient with recurring folliculitis on his residuum(trans-tibial
amp). He currently has a custom TEC liner and uses medicated A&D. The socket
was comfortable for him but the folliculitis persists.

There is a new laser depilatory system available that actually kills the hair
follicle. He is considering it.

Has anyone had experience with the remediation of folliculitis with the use
of depilitory agents?>>

Hello Mark,
Before I try to answer I need to know his age and frequency of this

problem, and obviously it must be occurring at pressure points only.

These problems were common during teenage/youth, however it also

needs attention to use only pure cotton socks,and give relief in that

particular area to keep patient/Disabled mobile, of course its very

painful and could be easily be solved during immediate development

by applying coconut hair oil or skin ointment/cream containing


Betamethasone Valerate I.P. 0.60mg

Gentamicin(as Sulphate) I.P. 1.00mg

Tolnaftate U.S.P. 10.00mg

Iodochlorohydroxyquinoline I.P. 10.00mg


Broadspectrum SKEEN cream for infected and inflamed skin

It will give immediate relief to Folliculitis.


I hope I have explained briefly as per my own PAST experience.


Rabinder Singh Sahni

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Dear Mark,


Did the patient have problems with folliculitis before wearing the TEC and

white A&D? The reason I am asking, is because A&D changed the formula

awhile back and added more zinc oxide. The result is the patient dries out

while wearing the liner re: potential skin problems. Change lubricants

(possibly A&D original) and see if the skin settles down.


Hope this is helpful,


Lisa Schoonmaker, CPO
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Mark---
   I was at a meeting on Tissue Engineering last week. Several people gave
presentations on engineering skin for use in grafts. They related the
important role hair folicules play in generating and secreting growth
factors used in re-generation of new skin. As keeping a viable
integumentary layer is essential for prosthetic usage, I wouldn't advise
your patient to undergo a depilatory procedure to kill off his hair
folicules. I would contact a good dermatologist familiar with amputees'
problems first, to avoid unforseen long term problems.

Vern
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Mark,
I have several patients with the same problem, same circumstances. Hygiene
routine is always my first question after that I am perplexed as to how to
resolve the folliculitis- I would hope you will share your responses.
THanks for asking a good question!
Jerry Nelson CPO
---------------------
Have you considered the Alps liners with gel base versus silicone?

Sometimes that works better.
----------------------
Hi Mark:
No experience with depilatories but, I wear a TEC liner and recently trained
for and ran the New York Marathon.
I had some problems with folliculitis as well in the past. I found that the
Medicated A&D was drying out the follicles and causing the ingrown hair
problem. I switched to the prosthetic ointment made by ALPS which does not
have the Zinc Oxide in it like the medicated A&D does. I was also able to
reduced the amount of lub used as the non-medicated ointment is more viscous.
 It took a week or so and some extra attention to hygene (the Zinc Oxide
reduces the perspiration) but the problem went away.
Good luck, hope this helps.
Jack
-----------------
Hi Mark,

I have worked with a few individuals who develop folliculitus in the
popliteal area of their residuum. It usually occurs during the hot summer
months. One individual had laser dipilation at the advice of his
physician. I may be wrong, but if my memory is correct, he said it takes
several treatments to permanently eliminate the hair. Due to the cost of
the treatment, he only had one treatment but was very pleased with the
results. He has moved out of state and I have no additional info
regarding long term success of this treatment. You might recommend he
discuss it with his physician. I hope this helps.

James M. Mc Coy, C.P., L..P.
--------------------
From my own experience with it (we very fair-skinned types tend to get it

worst, apparently), I find that an antibacterial soap like SpectroGram (not

SpectroGel, which doesn't work worth beans) and a good stiff brush or loofah

works well. I haven't seen how this goes on a stump yet, but I figured it

was worth mentioning.


Bryan Steinnagel
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