Sycosis

Sycosis (from Greek σῦκον — fig, wine berry) is a chronic, recurrent purulent inflammation of hair follicles, characterized by the formation of confluent infiltrates. This disease is a form of deep pyoderma.

The pathological process is most often localized in the areas of growth of bristly hair on the face in men—in the area of the beard, mustache, less often—on the eyebrows, in the armpits or on the pubis. Sycosis is characterized by a persistent, long-term course with frequent exacerbations, which leads to significant psychological discomfort and cosmetic defects.

Aetiology and Pathophysiology

The direct causative agent of sycosis is almost always Staphylococcus aureus. However, the development of the disease is associated not simply with infection, but with a complex violation of the body’s reactivity.

The key role in the pathogenesis is played by hypersensitivity (sensitization) of the organism to the antigens of staphylococci. In this context, constant microinjury of the skin (shaving, friction) and the presence of foci of chronic infection (rhinitis, sinusitis, decayed teeth) create conditions for the introduction of the pathogen and maintenance of a continuous inflammatory process.

Predisposing factors:

• Endocrine disorders (diabetes mellitus, gonadal dysfunction).
• Decreased general and local immunity.
• Functional disorders of the nervous system.
• Chronic nasopharyngeal infections.

Clinical Significance

The disease begins with the appearance of small pustules (ostiofolliculitis) pierced in the center by a hair. Soon the process spreads to neighboring follicles, pustules merge, and extensive, dense, bluish-red infiltrates are developed instead.

Clinical presentation:

• The affected skin is swollen, tense, and painful.
• Many small pustules are located on the surface of the infiltrates.
• The hair in the lesion is firmly seated in the follicles and is difficult to remove.
• When the pustules are cleared up, massive yellow-green purulent crusts are formed, after removal of which the surface becomes wet.
• The process proceeds in a wave-like manner, with periods of exacerbations and incomplete remissions, gradually taking over more and more areas.

Diagnosis is made on the basis of a typical clinical presentation. Treatment of sycosis is long and complex. It includes systemic antibiotic therapy based on the sensitivity of the pathogen, immunomodulation therapy (staphylococcal anatoxin, autovaccines), as well as rigorous local care (antiseptic lotions, ointments with antibiotics). An important part of the treatment is removal of the affected hair to allow pus to drain from the follicles.

Differential Diagnosis

Sycosis must be distinguished from other diseases with a similar pattern. It differs from acne vulgaris by the absence of comedones and the predominant lesion of hair follicles rather than sebaceous glands. It differs from the pustular form of rosacea by the presence of true purulent discharge and the absence of telangiectasias. The most important is the differential diagnosis with deep trichophytosis (“parasitic sycosis”), a fungal lesion of the beard area. To rule out fungal infection, microscopic and culture examination of the affected hair for fungi is mandatory.