Perianal Folliculitis: Symptoms, Recovery, and Concerns - Surgery

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Perianal folliculitis


Hello Doctor: At the beginning of June, I developed two folliculitis lesions about one centimeter to the left of my anus.
Initially, they were pinhead-sized conical papules, gradually growing to about 0.8 centimeters.
One of them is painful, causing discomfort when bending over to sit, and feels firmer, but has not produced pus; the other one is completely painless, has produced pus, and has two pus heads that feel separate from each other.
After a little over a week, there was no further inflammation.
Now, two months later, it has not fully healed.
The previously more painful lesion feels like there is some secretion inside, with a slight fluctuation sensation, and the surface is somewhat red, about 0.2-0.3 centimeters in size; the painless lesion has two shallow pits on the surface, but they appear to be skin-like, not open wounds, resembling scars.
Both lesions no longer have hard lumps, tenderness, or swelling; when relaxed, the surface is flat, and the skin color is lighter than the surrounding area, appearing white or pink.
During these two months, there has been no recurrence of inflammation or new lesions.
I consulted a colorectal surgeon who diagnosed it as folliculitis, but I am a bit concerned about the healing speed, fearing it might be suppurative hidradenitis, although the symptoms do not seem to match.
It is also uncommon for women to develop it around the anal area, and I have not had lesions in other common areas.
I would like to ask the doctor if the secretions in folliculitis will be absorbed by the body over time? Is my recovery process normal? Could it possibly be hidradenitis?

Xie, 20~29 year old female. Ask Date: 2023/08/04

Dr. Chen Bingze reply Surgery


Hello, I understand that the inflammatory condition in this area must be quite bothersome for you.
Whether it's folliculitis or hidradenitis, both are types of inflammatory responses.
You should have consulted a colorectal surgeon, who should have also assessed the possibility of an anal fistula.
Overall, it sounds like you are improving, as there is no persistent redness, swelling, heat, or pain, which is a good sign.
Unless there is a hard lump or other signs of redness and swelling, surgical removal may be considered.

Reply Date: 2023/08/04

More Info


Perianal folliculitis is a localized inflammation of the hair follicles around the anal region, which can present with various symptoms and recovery patterns. Based on your description, it seems you have experienced two distinct lesions that initially presented as small, pointed papules and have since evolved in size and characteristics.

Symptoms and Characteristics
1. Initial Presentation: The lesions began as small bumps, which is typical for folliculitis. The presence of pain in one lesion and the absence of pain in the other suggests that there may be varying degrees of inflammation or infection.


2. Current Condition: You mentioned that one lesion has a slight discharge and has a fluctuating sensation, while the other appears to have superficial changes resembling scarring. The fact that both lesions have not shown signs of recurrent inflammation or new lesions is a positive sign, indicating that the acute phase may have resolved.

3. Discharge and Healing: The presence of a small amount of discharge or fluctuation within the lesion could indicate that there is still some residual inflammation or a small collection of fluid. In many cases, the body can absorb this fluid over time, leading to gradual healing. However, if the discharge persists or increases, it may warrant further evaluation.


Recovery and Concerns
1. Normal Healing Process: The healing process for folliculitis can vary significantly among individuals. It is not uncommon for lesions to take several weeks to months to fully resolve, especially if there was significant inflammation or if the lesions were larger. Your observation that the lesions have not worsened and that there are no new lesions is reassuring.

2. Potential for Other Conditions: While your symptoms align with folliculitis, your concern about possible hidradenitis suppurativa (HS) is valid, especially if there is a history of recurrent abscesses or lesions in other areas. However, HS typically presents with more recurrent and painful nodules or abscesses, often in areas where skin rubs together. Given that you have not experienced similar lesions elsewhere, the likelihood of HS may be lower.

3. Follow-Up: Since you have already consulted with a colorectal surgeon who diagnosed folliculitis, it may be beneficial to continue monitoring the lesions. If you notice any changes in size, color, or if new symptoms arise (such as increased pain, fever, or spreading redness), it would be prudent to seek further medical evaluation.


Recommendations
- Observation: Continue to observe the lesions for any changes. If they remain stable or improve, this is a good sign.
- Hygiene: Maintain good hygiene in the area to prevent any potential secondary infections. Gentle cleansing with mild soap and water can help.

- Avoid Irritation: Wear loose-fitting clothing to minimize friction in the area, which can exacerbate symptoms.

- Consultation: If you have ongoing concerns about the healing process or if new symptoms develop, consider a follow-up appointment with your healthcare provider. They may recommend further diagnostic tests or treatments if necessary.

In conclusion, while your symptoms are consistent with perianal folliculitis, the healing process can vary. The absence of new lesions and the lack of recurrent inflammation are positive indicators. However, if you have ongoing concerns or if the lesions do not continue to improve, further evaluation may be warranted to rule out other conditions.

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