What is the treatment for generalized body folliculitis?

From the Guidelines

Generalized body folliculitis is typically treated with a combination of topical and oral therapies, with first-line options including cephalexin, dicloxacillin, or doxycycline for 7-14 days, as these antibiotics have been shown to be effective against Staphylococcus aureus, the most common cause of folliculitis 1.

Treatment Approach

When treating generalized body folliculitis, it's essential to consider the severity of the condition and the potential underlying causes. For mild cases, daily cleansing with antibacterial soaps containing chlorhexidine or benzoyl peroxide, followed by application of topical antibiotics like clindamycin 1% or mupirocin 2% ointment twice daily for 7-10 days, may be sufficient.

• Avoid tight clothing, excessive heat, and sharing personal items to prevent spread
• Use warm compresses to help drain pustules
• Consider underlying conditions like diabetes or immunosuppression if folliculitis persists despite treatment

Oral Antibiotics

For moderate to severe cases, oral antibiotics are recommended, with first-line options including:

• Cephalexin (500mg four times daily)
• Dicloxacillin (500mg four times daily)
• Doxycycline (100mg twice daily) for 7-14 days If MRSA is suspected, consider trimethoprim-sulfamethoxazole (one double-strength tablet twice daily) 1.

Recurrent Cases

Recurrent cases may benefit from:

• Dilute bleach baths (1/4 cup bleach in a full bathtub) twice weekly
• Maintenance antibacterial washes These treatments work by reducing the bacterial load on the skin, primarily Staphylococcus aureus, while also decreasing inflammation in the hair follicles 1.

From the Research

Treatment Options for Generalized Body Folliculitis

• The treatment for generalized body folliculitis may involve the use of oral antibiotics, such as cefadroxil, flucloxacillin, azithromycin, and cefaclor, as well as topical antiseptics and antibiotics 2.
• However, the use of antibiotics may lead to the development of resistant bacteria and have a high relapse rate, as seen in the treatment of folliculitis decalvans 3.
• Oral isotretinoin has been shown to be an effective treatment for folliculitis decalvans, with a success rate of 90% in achieving stable remission 3.
• For bacterial folliculitis and boils, comparative trials have not identified important differences in efficacy or safety outcomes between different oral antibiotics 2.
• The choice of antibacterial should take into account efficacy, cost-effectiveness, benefit-risk ratios, patient acceptability, and the potential for the development of resistance 4.
• Measures to prevent the development of resistance include prescribing antibacterials for an average of 6 months, utilizing the same antibacterial for retreatment, and avoiding concomitant use of oral and topical chemically-dissimilar antibacterials 4.

Considerations for Treatment

• The treatment of generalized body folliculitis should be individualized based on the severity of the disease, patient factors, and the potential for antibiotic resistance 2, 4.
• Systemic isotretinoin may be considered if several antibacterials have been tried without success 4.
• Topical antiseptics, such as benzoyl peroxide, and retinoids may be used in conjunction with oral antibiotics to enhance treatment efficacy 4.
• The use of phototherapy and incision and drainage may also be considered for the treatment of bacterial folliculitis and boils 2.