From the Guidelines
Folliculitis should be treated with gentle washing using antibacterial soap and over-the-counter topical antibiotics like bacitracin or neomycin for mild cases, while more severe cases may require prescription-strength topical or oral antibiotics, as well as hot compresses to reduce inflammation and prevent recurrence. According to the practice guidelines for the diagnosis and management of skin and soft tissue infections updated by the Infectious Diseases Society of America in 2014 1, folliculitis is distinguished from furuncles and carbuncles by its superficial inflammation limited to the epidermis. Key characteristics of folliculitis include:
- Inflammation of hair follicles
- Small, red bumps or white-headed pimples around hair follicles
- Typically caused by Staphylococcus aureus bacteria
- Risk factors include excessive sweating, shaving, tight clothing, hot tub use, and certain medical conditions like diabetes or compromised immunity Treatment strategies for folliculitis may involve:
- Keeping the affected area clean with gentle washing using antibacterial soap
- Applying over-the-counter topical antibiotics like bacitracin or neomycin 2-3 times daily for 7-10 days for mild cases
- Using prescription-strength topical antibiotics such as clindamycin 1% or mupirocin 2% applied twice daily for 7-14 days for more persistent cases
- Administering oral antibiotics like cephalexin (500mg four times daily) or doxycycline (100mg twice daily) for 7-14 days for widespread or severe folliculitis
- Applying hot compresses to affected areas for 15-20 minutes several times daily to help drain pustules and reduce inflammation
- Preventing recurrence by avoiding tight clothing, practicing good hygiene, changing razors frequently, and avoiding sharing personal items, as suggested by general medical knowledge and the principles outlined in the guidelines 1.
From the Research
Definition and Prevalence of Folliculitis
- Folliculitis is a globally prevalent bacterial infection involving inflammation of the hair follicle and the perifollicular tissue 2
- It may resolve spontaneously, but others may progress to boils without treatment 2
Types of Folliculitis
- Bacterial folliculitis and boils are two types of folliculitis, with boils also known as furuncles, involving adjacent tissue and may progress to cellulitis or lymphadenitis 2
- Follicular contact dermatitis is another type, which clinically presents as individual papules that include a central hair follicle 3
Causes and Risk Factors
- Several agents, either as allergens or irritants, have been reported to elicit follicular contact dermatitis, including topical antibiotics such as neomycin 3
- Patient allergenicity, characteristics of the agent, vehicle containing the agent, application of the agent, and external factors may contribute to the selective involvement of the follicles in follicular contact dermatitis 3
Treatment and Management
- The primary therapeutic intervention for follicular contact dermatitis is withdrawal of the causative agent 3
- Treatment with a topical corticosteroid preparation may also promote resolution of the dermatitis 3
- For bacterial folliculitis and boils, interventions such as topical antibiotics, topical antiseptic agents, systemic antibiotics, phototherapy, and incision and drainage may be used 2
- However, comparative trials have not identified important differences in efficacy or safety outcomes between different oral antibiotics for treating bacterial folliculitis or boils 2
Diagnosis and Differential Diagnosis
- The differential diagnosis of follicular contact dermatitis includes not only recurrent infundibulofolliculitis, but also drug eruption, mite infestation, viral infection, and dermatoses that affect hair follicles 3
- Pathologic features of follicular contact dermatitis involve the follicle and the surrounding dermis: spongiosis and vesicle formation of the follicular epithelium associated with perifollicular and perivascular lymphocytic inflammation 3