From the Guidelines
Folliculitis should be treated with gentle antibacterial soap and warm water twice daily, and for mild cases, over-the-counter topical antibiotics like bacitracin or polymyxin B can be applied 2-3 times daily for 7-10 days. Folliculitis is a common skin condition characterized by inflammation of hair follicles, resulting in small red bumps or white-headed pimples around hair follicles. According to the guidelines for the diagnosis and management of skin and soft tissue infections 1, folliculitis differs from furuncles, in which the inflammation is more superficial and pus is limited to the epidermis. Some key points to consider in the treatment of folliculitis include:
- Keeping the affected area clean with gentle antibacterial soap and warm water twice daily
- Applying over-the-counter topical antibiotics like bacitracin or polymyxin B 2-3 times daily for 7-10 days for mild cases
- Using prescription-strength treatments such as clindamycin lotion, erythromycin gel, or oral antibiotics like cephalexin or doxycycline for more severe or persistent cases
- Applying warm compresses for 15-20 minutes several times daily to relieve discomfort and promote drainage
- Preventing recurrence by avoiding tight clothing, practicing good hygiene, changing out of sweaty clothes promptly, avoiding sharing personal items like razors, and using clean towels and washcloths, as suggested by the guidelines for the diagnosis and management of skin and soft-tissue infections 1. Folliculitis occurs when hair follicles become damaged and infected, most commonly by Staphylococcus aureus bacteria, though other bacteria, fungi, or viruses can also cause it, and risk factors include excessive sweating, tight clothing, skin injuries, and certain medical conditions like diabetes or compromised immunity 1.
From the Research
Definition and Prevalence of Folliculitis
- Bacterial folliculitis and boils are globally prevalent bacterial infections involving inflammation of the hair follicle and the perifollicular tissue 2
- Some folliculitis may resolve spontaneously, but others may progress to boils without treatment 2
Treatment Options for Folliculitis
- Interventions for bacterial folliculitis and boils include topical antibiotics, topical antiseptic agents, systemic antibiotics, phototherapy, and incision and drainage 2
- A systematic review of 18 RCTs (1300 participants) compared different oral antibiotics, but found no RCTs comparing topical antibiotics against topical antiseptics, topical antibiotics against systemic antibiotics, or phototherapy against sham light 2
Efficacy and Safety of Oral Antibiotics
- Comparative trials have not identified important differences in efficacy or safety outcomes between different oral antibiotics for treating bacterial folliculitis or boils 2
- There may be little to no difference in clinical cure rate between cefdinir and cefalexin, cefditoren pivoxil and cefaclor, or azithromycin and cefaclor 2
- There may be an increased risk of severe adverse events with cefadroxil compared with flucloxacillin, and cefditoren pivoxil compared with cefaclor, but the 95% CI is very wide and includes the possibility of both increased and reduced risk of events 2
Limitations and Future Directions
- Most of the included studies assessed participants with skin and soft tissue infection which included many disease types, whilst others focused specifically on folliculitis or boils 2
- Antibiotic sensitivity data for causative organisms were often not reported, and future trials should incorporate culture and sensitivity information 2
- Future trials should consider comparing topical antibiotic with antiseptic, and topical versus systemic antibiotics or phototherapy 2