From the Guidelines
To treat folliculitis on a hairy chest, start with gentle cleansing using antibacterial soap like Hibiclens or benzoyl peroxide wash (5-10%) once or twice daily, as this approach is supported by the most recent and highest quality study available 1. When considering treatment options, it's essential to prioritize gentle and effective methods to avoid exacerbating the condition.
- Apply over-the-counter topical treatments such as benzoyl peroxide 2.5-5% gel, clindamycin 1% solution, or mupirocin 2% ointment to affected areas 2-3 times daily for 7-10 days.
- For more severe cases, consider oral antibiotics like doxycycline (100mg twice daily) or cephalexin (500mg four times daily) for 7-14 days, which your doctor can prescribe, as suggested by 1.
- Warm compresses applied for 15 minutes several times daily can help drain pustules, and it is crucial to avoid tight clothing, use fresh towels and bedding, and not share personal items to prevent the spread of infection.
- Consider trimming chest hair (not shaving) to reduce irritation and improve topical treatment penetration, as folliculitis occurs when hair follicles become infected with bacteria (commonly Staphylococcus aureus), fungi, or become irritated from friction, making the hairy chest particularly susceptible due to sweat, friction, and trapped bacteria 1. It's also important to note that greasy creams and manipulations of the skin should be avoided, as they may facilitate the development of folliculitis or increase the risk of infection, as mentioned in 1. Overall, the treatment approach should focus on gentle cleansing, effective topical treatments, and preventive measures to avoid the spread of infection and reduce the risk of complications.
From the Research
Hairy Chest Folliculitis Treatment
- The treatment of hairy chest folliculitis is similar to that of other forms of folliculitis, with a focus on reducing inflammation and preventing infection 2, 3.
- Oral antibiotics, such as clindamycin and rifampicin, clarithromycin, and dapsone, have been used to treat folliculitis, but they have a high relapse rate and can encourage the development of resistant bacteria 2.
- Isotretinoin has been shown to be an effective treatment for folliculitis decalvans, with 90% of patients experiencing stable remission during and up to two years after cessation of treatment 2.
- Topical antibiotics and antiseptics, such as benzoyl peroxide, may also be used to treat folliculitis, but there is limited evidence on their effectiveness compared to oral antibiotics 3.
- Phototherapy and incision and drainage may also be used to treat folliculitis, but there is limited evidence on their effectiveness 3.
Treatment Options
- Oral isotretinoin: 90% of patients experienced stable remission during and up to two years after cessation of treatment 2.
- Clindamycin and rifampicin: low success rate in achieving long-term remission, with 80% of patients relapsing shortly after end of treatment 2.
- Clarithromycin and dapsone: more successful than clindamycin and rifampicin, with long-term and stable remission rates of 33% and 43% respectively 2.
- Cefadroxil, flucloxacillin, azithromycin, and cefaclor: uncertain whether they differ in clinical cure rate, with very low-certainty evidence 3.
- Cefdinir and cefalexin: may have little to no difference in clinical cure rate, with low-certainty evidence 3.
- Cefditoren pivoxil and cefaclor: may have little to no difference in clinical cure rate, with moderate-certainty evidence 3.