PUID: 57 || PLAB 2 Mock :: Dermatology: Folliculitis
- examiner mla
- Aug 10
- 2 min read
Updated: Aug 16
Summary
This PLAB 2 scenario involves an 18-year-old female presenting with an itchy, burning rash in the groin area after a Brazilian wax. The candidate must differentiate between benign causes such as folliculitis and more serious sexually transmitted infections (STIs), address the patient’s embarrassment, and provide safe, evidence-based management while maintaining patient-centred communication.
Key Points
Dermatology / Infectious Disease
Folliculitis: superficial inflammation of hair follicles, often due to bacterial infection or irritation (e.g., post-waxing).
Differential diagnoses: genital herpes, other STIs, contact dermatitis, candidiasis.
Important to clarify lesion number, location, distribution, and associated symptoms.
Sexual Health
Rule out STIs through targeted sexual history: activity, new partners, protection use, associated discharge or dysuria.
Patient concern about STIs must be directly addressed to reduce anxiety.
History Taking Essentials
Onset and progression of rash.
Trigger factors: waxing technique, hygiene, products applied post-waxing.
Associated symptoms: pain, swelling, fever, urinary symptoms, vaginal discharge.
Past medical history, allergies, medications.
Socio-sexual history (PMAFTOs: Partners, Menstrual history, Allergies, Family history, Travel history, Occupation).
Important Considerations
Maintain a non-judgemental approach to sensitive and intimate complaints.
Avoid ambiguous phrases (“Did you follow post-wax advice?”) unless clearly explained.
Explore possible allergic or irritant reactions to products used after waxing.
Distinguish localised from systemic infection (vital signs, lymphadenopathy).
Address patient embarrassment early and build rapport.
Diagnostic Approach
History:
Presenting complaint (Socrates approach).
Relevant dermatological, sexual, and systemic history.
Examination:
Inspection of rash, genital exam (with consent and chaperone).
Check inguinal lymph nodes.
Assess temperature and systemic signs.
Differential Diagnosis:
Folliculitis (most likely in this case).
Herpes simplex virus.
Contact dermatitis.
Candidiasis.
Investigations (if indicated):
Swab for bacterial culture if recurrent or severe.
STI screening if suspicion remains.
Management
Explain Diagnosis: Likely folliculitis secondary to irritation from waxing.
Lifestyle / Supportive Care:
Avoid further waxing/shaving until healed.
Warm compresses 10–15 min, 3–4 times/day.
Keep area clean and dry; use mild, non-perfumed soap.
Avoid tight underwear.
Medical Treatment:
Topical antiseptics (chlorhexidine) or topical antibiotics (fusidic acid) for mild cases.
Oral antibiotics only if spreading or severe.
Prevention Advice:
Shave/wax in direction of hair growth.
Use clean, sharp razors and alcohol-free aftercare.
Consider salicylic acid lotion post-waxing to reduce follicular blockage.
Safety Netting:
Seek review if pain, swelling, fever, spreading redness, or recurrent lesions.
Follow-up if no improvement in 5–7 days.
STI Reassurance: Based on presentation, not consistent with STI.
Communication Skills
Acknowledge and validate embarrassment.
Explain role, reassure about professional experience with intimate conditions.
Use clear, jargon-free language.
Avoid over-rehearsed stock phrases; be genuine.
Encourage open dialogue about sexual history in a sensitive manner.
Involve patient in management decisions.
Ethical Considerations
Maintain dignity and privacy (offer chaperone for examination).
Ensure informed consent for examination and treatment.
Respect confidentiality, but reassure only if patient appears concerned about it.
Avoid assumptions based on location of rash – use evidence from history/exam.
Additional Resources
GMC Good Medical Practice – Communication and confidentiality standards.
NICE CKS – Folliculitis: https://cks.nice.org.uk/topics/folliculitis
UK Health Security Agency – STI testing guidance.
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