Progressive Folliculitis in a 25-Year-Old Male Mechanic

Case at a Glance

A 25-year-old male mechanic presented with rapidly spreading inflammatory papules and pustules across multiple body regions, causing significant pain and functional impairment.

Patient's Story

The patient, a 25-year-old male working as an automotive mechanic, reported the sudden appearance of a skin eruption that began as small lesions on his legs. Despite maintaining good hygiene practices with daily 30-minute showers to remove occupational contaminants, the condition rapidly progressed over several days. The lesions spread from the initial site on his legs to involve his neck, beard area, axillae, and upper extremities. The patient described severe pain that interfered with basic activities such as sitting and standing, along with significant pruritus. He expressed concern about the rapid progression and potential for further spread.

Initial Assessment

Physical examination revealed multiple inflammatory papules and pustules of varying sizes distributed across the lower extremities, neck, perioral region, axillary areas, and upper arms. The lesions appeared as follicle-centered inflammatory bumps, some containing purulent material and others showing hemorrhagic crusting with dark red discoloration suggestive of deeper inflammation. The patient demonstrated significant tenderness to palpation and appeared distressed by the extent of involvement.

The Diagnostic Journey

Given the follicle-centered distribution, occupational exposure history, and rapid progression, the clinical presentation was most consistent with bacterial folliculitis. The patient's work environment as a mechanic involves exposure to oils, grease, and other potentially comedogenic substances that could contribute to follicular occlusion and secondary bacterial infection. Differential considerations included fungal folliculitis, hidradenitis suppurativa (given axillary involvement), or contact dermatitis with secondary bacterial infection.

Final Diagnosis

Severe bacterial folliculitis with widespread distribution, likely Staphylococcus aureus-related, exacerbated by occupational exposures in an automotive work environment.

Treatment Plan

Given the extensive involvement and systemic symptoms, the patient was started on oral antibiotic therapy with clindamycin 300mg three times daily for 10-14 days. Topical mupirocin ointment was prescribed for twice-daily application to affected areas. Patient education was provided regarding gentle cleansing with antibacterial soap, avoiding manipulation of lesions, and wearing loose-fitting, breathable clothing. Occupational modifications were discussed, including more frequent hand washing and consideration of protective barriers when working with oils and mechanical fluids.

Outcome and Follow-up

The patient was scheduled for follow-up in one week to assess treatment response. Instructions were given to return sooner if symptoms worsened or if signs of systemic infection developed. Given the rapid progression and severity, close monitoring was deemed essential to prevent complications such as cellulitis or abscess formation. Long-term prevention strategies focused on occupational hygiene measures and early intervention for any recurrent symptoms.