What is the treatment for acute folliculitis?

From the Guidelines

Acute folliculitis can typically be treated at home with warm compresses applied to the affected area 3-4 times daily for 15-20 minutes to reduce inflammation and promote drainage. Gentle cleansing with antibacterial soap like chlorhexidine or benzoyl peroxide wash (5-10%) once or twice daily helps eliminate bacteria [ 1 ]. Over-the-counter topical antibiotics such as bacitracin, neomycin, or mupirocin can be applied thinly to affected areas 2-3 times daily for 7-10 days. For more widespread or persistent cases, a healthcare provider may prescribe oral antibiotics like cephalexin (500mg four times daily), dicloxacillin (500mg four times daily), or doxycycline (100mg twice daily) for 7-10 days. These treatments work by killing the bacteria, typically Staphylococcus aureus, that infect hair follicles and cause inflammation.

Key Considerations

• Avoid shaving the affected area
• Wear loose clothing to prevent friction
• Don't share personal items like towels or razors to prevent spreading the infection
• If folliculitis doesn't improve within a week, worsens, or recurs frequently, medical evaluation is necessary as it may indicate a resistant infection or underlying condition requiring different treatment [ 1 ].

Prevention of Recurrence

For individuals with recurrent furunculosis, the use of antibacterial agents to eradicate staphylococcal carriage is recommended [ 1 ]. Applying mupirocin ointment twice daily in the anterior nares for the first 5 days each month can reduce recurrences by ∼50%. Alternatively, a single oral daily dose of 150 mg of clindamycin for 3 months can decrease subsequent infections by ∼80%.

From the FDA Drug Label

A small amount of mupirocin ointment should be applied to the affected area three times daily. The treatment for acute folliculitis may include applying mupirocin ointment to the affected area three times daily.

• Apply a small amount of mupirocin ointment to the affected area
• Cover the area with a gauze dressing if desired
• Re-evaluate patients who do not show a clinical response within 3 to 5 days 2

From the Research

Treatment Options for Acute Folliculitis

• The treatment of acute folliculitis may involve the use of topical or oral antibiotics, as well as other interventions such as incision and drainage 3.
• A systematic review of 18 randomized controlled trials (RCTs) found that the use of oral antibiotics such as cefadroxil, azithromycin, and cefdinir may be effective in treating bacterial folliculitis, but the evidence is generally of low or very low certainty 3.
• Topical antibiotics such as fusidic acid may also be used to treat folliculitis, and have been shown to be effective in reducing the prevalence of Staphylococcus aureus in patients with atopic eczema 4.
• However, the use of topical fusidic acid has also been linked to the development of resistance in Staphylococcus aureus, and its use should be carefully considered 5.

Comparison of Treatment Options

• A study comparing the use of cefadroxil and flucloxacillin found that there may be little to no difference in clinical cure rate between the two antibiotics, but the evidence is of very low certainty 3.
• Another study found that the use of fusidic acid ointment may be effective in preventing relapses of staphylococcal furunculosis, and may have a permanent effect in up to 80% of patients 6.
• A clinical audit found that previous use of topical fusidic acid was an independent risk factor for the development of fusidic acid resistance in Staphylococcus aureus 5.

Adverse Events and Safety

• The use of oral antibiotics such as cefadroxil and cefdinir may be associated with adverse events such as diarrhea, nausea, and vomiting 3.
• Topical antibiotics such as fusidic acid may also be associated with adverse events such as skin irritation and allergic reactions 4.
• The development of resistance in Staphylococcus aureus is a significant concern with the use of topical fusidic acid, and its use should be carefully considered 5.