From the Guidelines
Folliculitis treatment should prioritize topical antibiotics and proper skin care, with oral antibiotics reserved for moderate to severe cases, as this approach has been shown to effectively reduce morbidity and improve quality of life 1.
Treatment Approach
When managing folliculitis, it's essential to differentiate it from furuncles and carbuncles, which are infections of the hair follicle that extend into the subcutaneous tissue. According to the 2014 practice guidelines for the diagnosis and management of skin and soft tissue infections, folliculitis is a superficial inflammation of the hair follicle, whereas furuncles and carbuncles are more severe infections that may require incision and drainage 1.
Topical Treatments
For mild cases of folliculitis, topical antibiotics such as clindamycin 1% or mupirocin 2% should be applied to affected areas twice daily for 7-10 days. Additionally, benzoyl peroxide washes (5-10%) used daily can help reduce bacteria on the skin. Warm compresses applied to affected areas 3-4 times daily for 15-20 minutes can also help reduce inflammation and promote drainage.
Oral Antibiotics
For moderate to severe cases, oral antibiotics such as dicloxacillin 250-500mg four times daily, cephalexin 500mg twice daily, or doxycycline 100mg twice daily for 7-14 days may be necessary. However, it's crucial to note that systemic antimicrobials are usually unnecessary unless fever or other evidence of systemic infection is present 1.
Recurrent Cases
For recurrent or resistant cases, consider oral antifungal treatment with fluconazole 150mg weekly for 2-4 weeks if fungal folliculitis is suspected. Eradication of staphylococcal carriage, particularly in the anterior nares, can also be achieved through the use of mupirocin ointment twice daily for the first 5 days each month, which can reduce recurrences by ∼50% 1.
Prevention and Hygiene
Maintaining good hygiene is essential in preventing the spread of folliculitis. This includes washing affected areas with antibacterial soap, avoiding sharing personal items, wearing loose-fitting clothing, and changing out of sweaty clothes promptly. By prioritizing topical antibiotics, proper skin care, and good hygiene, patients with folliculitis can effectively manage their symptoms and reduce the risk of complications.
From the Research
Treatment Guidelines for Folliculitis
- The treatment of folliculitis depends on the type and severity of the condition, with various options available including antibiotics, antiseptics, and phototherapy 2, 3, 4.
- For folliculitis decalvans, oral isotretinoin has been shown to be an effective treatment, with a success rate of 90% in achieving stable remission 2.
- Topical antibiotics and antiseptics may be used to treat mild cases of folliculitis, while systemic antibiotics may be necessary for more severe cases 3, 4.
- Photodynamic therapy has been reported to be effective in treating recalcitrant folliculitis barbae and pseudofolliculitis barbae 5.
- Eosinophilic pustular folliculitis may be treated with oral indomethacin, oral cyclosporine, or topical tacrolimus ointment, with varying degrees of effectiveness 6.
Comparison of Treatment Options
- A systematic review of 18 randomized controlled trials found that comparative trials have not identified important differences in efficacy or safety outcomes between different oral antibiotics for treating bacterial folliculitis or boils 3.
- The review also found that there is a lack of evidence on the efficacy and safety of topical antibiotics versus antiseptics, topical versus systemic antibiotics, or phototherapy versus sham light for treating bacterial folliculitis or boils 3.
Considerations for Treatment
- The choice of treatment should be based on the severity and type of folliculitis, as well as the patient's medical history and potential allergies or sensitivities 2, 3, 4.
- Treatment should also take into account the potential for antibiotic resistance and the need for culture and sensitivity testing to guide treatment decisions 3.