What is the treatment for folliculitis?

From the Guidelines

Folliculitis treatment should prioritize avoiding greasy creams, manipulation of skin, hot blow-drying of hair, and wearing tight shoes, as these can exacerbate the condition or lead to infection 1. When treating folliculitis, it's essential to consider the underlying cause and avoid irritants that can worsen the condition.

• Avoiding greasy creams is crucial, as they can facilitate the development of folliculitis due to their occlusive properties 1.
• Manipulation of the skin should also be avoided, as it poses a risk of infection 1.
• Hot blow-drying of hair and wearing tight shoes can also contribute to the development of folliculitis and should be avoided 1. In terms of treatment,
• topical antibiotics may be used to treat bacterial folliculitis, but there is no specific mention of this in the provided evidence.
• for fungal folliculitis, antifungal creams or oral medications may be prescribed, but again, this is not explicitly stated in the provided evidence. However, based on the available evidence,
• daily cleansing with gentle soap and avoiding irritants can help manage the condition 1.
• maintaining good hygiene, avoiding tight clothing, and changing out of sweaty clothes promptly can also help prevent recurrence. It's also important to note that
• secondary infection of skin rash may occur, and bacterial swabs should be taken to guide anti-infective treatment 1.
• abscesses may require incision and drainage to prevent sepsis 1.

From the FDA Drug Label

A small amount of mupirocin ointment should be applied to the affected area three times daily. The treatment for folliculitis with mupirocin ointment is to apply a small amount to the affected area three times daily. Key points to consider:

• Apply a small amount of ointment
• Apply three times daily
• The area may be covered with a gauze dressing if desired
• Re-evaluate patients if there is no clinical response within 3 to 5 days 2

From the Research

Treatment Options for Folliculitis

• The treatment for folliculitis can vary depending on the cause and severity of the condition 3.
• For bacterial folliculitis, treatment options may include topical or oral antibiotics, such as cefadroxil, flucloxacillin, azithromycin, and cefaclor 4.
• A systematic review of 18 randomized controlled trials found that there may be little to no difference in clinical cure rates between different oral antibiotics, such as cefdinir and cefalexin 4.
• However, the review also found that some antibiotics, such as cefadroxil and cefditoren pivoxil, may have a higher risk of severe adverse events leading to treatment withdrawal 4.
• For folliculitis decalvans, a retrospective study found that oral isotretinoin was the most effective treatment, with 90% of patients experiencing stable remission during and up to two years after cessation of treatment 5.
• Other treatment options for folliculitis decalvans, such as clindamycin and rifampicin, clarithromycin, and dapsone, had lower success rates and higher relapse rates 5.
• In cases where folliculitis is associated with cellulitis, empiric outpatient therapy with trimethoprim-sulfamethoxazole, cephalexin, or clindamycin may be effective 6.
• However, the choice of antibiotic should be guided by the presence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections, as well as the severity of the cellulitis and the patient's individual risk factors 6.

Considerations for Treatment

• The treatment of folliculitis should be individualized based on the cause and severity of the condition, as well as the patient's medical history and other factors 3.
• Antibiotic therapy should be guided by culture and sensitivity results, when available, and should be tailored to the specific needs of the patient 4, 6.
• Patients with folliculitis decalvans may require long-term treatment to achieve stable remission, and oral isotretinoin may be a viable option for these patients 5.
• In cases where folliculitis is associated with cellulitis, empiric outpatient therapy with antibiotics active against community-associated MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, may be preferred 6.