What are the management options for folliculitis?

From the Guidelines

Folliculitis management primarily involves topical treatments, with systemic antibiotics reserved for more severe cases, and preventive measures such as good hygiene and decolonization for recurrent cases.

Management Options

• For mild cases, topical antibiotics like clindamycin 1% or erythromycin 2% applied twice daily for 7-10 days are effective first-line treatments 1.
• Benzoyl peroxide 5-10% wash can also help by reducing bacteria and inflammation.
• For more extensive or resistant cases, oral antibiotics such as cephalexin (500mg four times daily), dicloxacillin (250-500mg four times daily), or doxycycline (100mg twice daily) for 7-14 days may be necessary.
• If MRSA is suspected, trimethoprim-sulfamethoxazole (one double-strength tablet twice daily) is preferred.

Preventive Measures

• For recurrent folliculitis, chlorhexidine 4% or bleach baths (1/4 cup bleach in a full bathtub) can decolonize the skin 1.
• Antifungal treatments like ketoconazole 2% shampoo or cream are appropriate for Pityrosporum folliculitis.
• Patients should also be advised to avoid tight clothing, practice good hygiene, use clean razors, and avoid sharing personal items.
• Hot tubs and pools should be properly maintained to prevent Pseudomonas folliculitis.

Treatment Rationale

These treatments work by targeting the causative organisms (bacteria or fungi) and reducing inflammation in the hair follicles, allowing them to heal properly. The most recent guidelines from 2014 support the use of topical and systemic treatments based on severity, as well as preventive measures for recurrent cases 1.

From the FDA Drug Label

A small amount of mupirocin ointment should be applied to the affected area three times daily. If a reaction suggesting sensitivity or chemical irritation should occur with the use of mupirocin ointment 2%, treatment should be discontinued and appropriate alternative therapy for the infection instituted.

The management options for folliculitis include applying a small amount of mupirocin ointment to the affected area three times daily. If sensitivity or chemical irritation occurs, treatment should be discontinued and alternative therapy instituted 2, 2.

• Key points:
  • Apply mupirocin ointment to the affected area three times daily
  • Discontinue treatment if sensitivity or chemical irritation occurs
  • Consider alternative therapy if treatment is discontinued

From the Research

Management Options for Folliculitis

The management of folliculitis involves various treatment approaches, including:

• Topical and oral antibiotics to control bacterial infections 3, 4, 5, 6
• Topical antiseptics, such as benzoyl peroxide, to reduce bacterial load 3
• Phototherapy, although its effectiveness is uncertain due to limited evidence 3
• Incision and drainage for boils or furuncles 3
• Oral glucocorticosteroids for short-term use in highly active disease 4
• Oral isotretinoin as a first-line therapy for mild active disease or refractory cases 4
• Photodynamic therapy, biologics, JAK inhibitors, oral dapsone, hydroxychloroquine, or cyclosporine as alternative treatments 4
• Topical or intralesional corticosteroids as adjunctive therapy 4
• Surgical excision or laser therapy for selected cases 4
• Hair transplantation in patients with inactive disease 4

Treatment Considerations

When managing folliculitis, it is essential to consider the following:

• The severity and extent of the disease
• The presence of underlying conditions or comorbidities
• The potential for antibiotic resistance or side effects
• The need for long-term treatment or maintenance therapy
• The importance of patient education and follow-up to monitor response to treatment and prevent recurrence 3, 4, 5

Specific Considerations for Folliculitis Decalvans

Folliculitis decalvans, a type of scarring alopecia, requires a tailored approach, including:

• Oral antibiotics as first-line therapy for moderate or severe inflammation 4
• Oral isotretinoin for mild active disease or refractory cases 4
• Alternative treatments, such as photodynamic therapy, biologics, or JAK inhibitors, for recalcitrant disease 4
• Topical or intralesional corticosteroids as adjunctive therapy 4
• Surgical excision or laser therapy for selected cases 4
• Hair transplantation in patients with inactive disease 4