From the Research
The treatment for folliculitis in the gluteal folds typically involves a combination of topical and oral therapies, with the most recent and highest quality study suggesting that oral antibiotics such as cefdinir or cefalexin may be effective for moderate to severe cases 1. For mild cases, start with good hygiene measures including daily cleansing with antibacterial soap like chlorhexidine or benzoyl peroxide washes (5-10%), followed by thorough drying of the area.
- Apply topical antibiotics such as clindamycin 1% or mupirocin 2% ointment twice daily for 7-10 days.
- For moderate to severe cases, oral antibiotics are recommended, with first-line options including cephalexin 500mg four times daily, doxycycline 100mg twice daily, or trimethoprim-sulfamethoxazole DS twice daily for 7-14 days.
- If MRSA is suspected, consider clindamycin 300-450mg four times daily. Some cases of folliculitis may be caused by fungal infections, such as Malassezia folliculitis, which may require treatment with oral antifungals like ketoconazole or azole antifungals 2, 3. Additionally, consider the following:
- Warm compresses for 15-20 minutes several times daily can help drain pustules.
- Wear loose-fitting, breathable cotton underwear and avoid tight clothing that causes friction.
- For recurrent cases, consider using chlorhexidine wash or diluted bleach baths (1/4 cup bleach in a full bathtub) twice weekly as maintenance therapy. These treatments are effective because they target the bacterial infection (often Staphylococcus aureus or Pseudomonas) while reducing inflammation and preventing bacterial colonization in hair follicles.