What is the treatment for chronic folliculitis?

From the Guidelines

The treatment for chronic folliculitis typically involves a combination of topical and oral medications, along with lifestyle modifications, with first-line treatment including topical antibiotics such as clindamycin 1% solution or benzoyl peroxide 5-10% gel applied twice daily to affected areas for 2-4 weeks, as supported by 1.

Key Considerations

• For more severe or resistant cases, oral antibiotics may be necessary, with options including doxycycline 100mg twice daily, minocycline 100mg twice daily, or cephalexin 500mg four times daily for 7-14 days.
• Antifungal treatments like ketoconazole 2% shampoo or cream can be effective if the folliculitis is caused by yeast or fungi.
• Daily cleansing with antibacterial soap or chlorhexidine wash helps reduce bacterial load on the skin.
• Warm compresses applied to affected areas for 15-20 minutes several times daily can help drain pustules and reduce inflammation.

Recurrent Cases

• For recurrent cases, maintenance therapy with benzoyl peroxide or weekly use of dilute bleach baths (1/4 cup of bleach in a full bathtub) may prevent flares, as suggested by 1.
• Addressing contributing factors such as occlusive clothing, excessive sweating, and sharing of personal items is also essential for long-term management.

Eradication of Staphylococcal Carriage

• The use of antibacterial agents to eradicate staphylococcal carriage, such as mupirocin ointment applied twice daily in the anterior nares for the first 5 days each month, can reduce recurrences by ∼50%, as reported in 1.
• Clindamycin is an exception, and probably the best program for recurrent furunculosis caused by susceptible S. aureus is a single oral daily dose of 150 mg of this agent for 3 months, which decreases subsequent infections by ∼80%, as supported by 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment Options for Chronic Folliculitis

• The treatment for chronic folliculitis can vary depending on the underlying cause and severity of the condition 2.
• According to a study published in 2015, oral isotretinoin was found to be the most effective treatment for folliculitis decalvans, with 90% of patients experiencing stable remission during and up to two years after cessation of treatment 3.
• Another study published in 2021 found that there is little to no difference in clinical cure rate between different oral antibiotics for treating bacterial folliculitis or boils, including cefadroxil, flucloxacillin, azithromycin, and cefaclor 4.
• Topical methyl aminolevulinate photodynamic therapy has also been found to be effective for the treatment of chronic folliculitis, particularly in areas of acne-prone skin 5.
• Cytology, a simple and rapid diagnostic method, can be used to reveal various bacterial, fungal, viral, and parasitic pathogens, and can aid in the differential diagnosis of folliculitis 6.

Considerations for Treatment

• The use of antibiotics as first-line therapy in folliculitis decalvans needs to be re-evaluated critically, and oral isotretinoin should be considered as a valid treatment alternative 3.
• The choice of treatment should be based on the underlying cause of the folliculitis, as well as the severity and extent of the condition 2.
• Future trials should incorporate culture and sensitivity information and consider comparing topical antibiotic with antiseptic, and topical versus systemic antibiotics or phototherapy 4.