treatment and prevention of folliculitis
Last edited 03/2021 and last reviewed 03/2021
Local measures:
- cleaning - use chlorhexidine and apply saline or aluminium subacetate soaks / compresses for 15 minutes, twice daily. Open the larger pustules and trim away any necrotic tissue. Anhydrous ethyl alcohol containing 6.25% aluminium chloride may be helpful.
General measures:
- systemic antibiotics e.g. flucloxacillin or clarithromycin (if penicillin-allergic) - only if local
treatment is ineffective; the infection is severe; or has become complicated
or involves the upper lip, nose or eyes from which a cavernous sinus thrombosis
may develop
- in general a 7 day course of antibiotic treatment is indicated for acute
folliculitis (1,2,3,4)
- for some cases of folliculiti a course of oral antibiotics may be administered over 7 to
10 days (5)
- for some cases of folliculiti a course of oral antibiotics may be administered over 7 to
10 days (5)
- chronic folliculitis may require prolonged antibiotic treatment e.g.
oxytetracycline for 6-8 weeks (however in cases of chronic folliculitis
it is important to swab lesions and consult with local microbiological
advice regarding antibiotic prescribing) (6)
- for antibiotic-resistant S aureus then consult local guidance
- clindamycin, tetracyclines,
trimethoprim-sulfamethoxazole, linezolid, or glycopeptide (e.g.parenteral vancomycin) may be used (7)
- clindamycin, tetracyclines,
trimethoprim-sulfamethoxazole, linezolid, or glycopeptide (e.g.parenteral vancomycin) may be used (7)
- in general a 7 day course of antibiotic treatment is indicated for acute
folliculitis (1,2,3,4)
- topical 2% mupirocin - 3 times daily and supported with dressings. Particularly valuable in eliminating primary or secondary infection.
Specific forms of folliculitis:
- hot tub folliculitis - pseudomonas folliculitis is a benign, self-limited
disorder (2) Showering after exposure to contaminated water does not seem
to prevent the disease
- hot water, a high pH, and low chlorine levels all predispose to infection - pseudomonas folliculitis can be prevented by proper maintenance and chlorination of pools, hot tubs, whirlpools, and spas to decrease the population of P. aeruginosa
- antibiotic treatment with ciprofloxacin may be used
- use of systemic antimicrobial agents should be considered in patients
with fever and constitutional symptoms or in patients with resistant
disease (3)
- use of systemic antimicrobial agents should be considered in patients
with fever and constitutional symptoms or in patients with resistant
disease (3)
- gram-negative folliculitis
- sometimes failure to respond to antibiotic therapy is due to development
of gram-negative folliculitis
- high dose trimethoprim - 300mg bd in adults - is the antibiotic of choice in these situations (3)
- isotretinoin has been successfully used to treat different forms of folliculitis including gram-negative folliculitis and HIV-associated eosinophilic folliculitis (4)
- sometimes failure to respond to antibiotic therapy is due to development
of gram-negative folliculitis
Prevention:
- correct precipitating factors:
- systemic eg. diabetes mellitus
- local eg. irritations, discharges
Reference:
- (1) Prescriber (2004); 15 (13): 35-40.
- (2) Yu Y et al. Hot tub folliculitis or hot hand-foot syndrome caused by Pseudomonas aeruginosa. J Am Acad Dermatol. 2007 Oct;57(4):596-600. Epub 2007 Jul 19.
- (3) Pulse (3/10/07):49.
- (4) Dermatology in Practice 2007;15(4):26-28.
- (5) Laureano AC et al. Facial bacterial infections: folliculitis. Clinics in Dermatology 2014;2(6):711-4.
- (6) Personal communication (23/5/12). Dr P Kenyon (GPSI Dermatology, Rugby Hospital)
- (7) Nagaraju U et al. Methicillin resistant Staphylococcus aureus in community-acquired pyoderma. International Journal of Dermatology 2004;43(6):412-4.