From the Guidelines
Folliculitis can be effectively treated with a combination of home remedies and medications, prioritizing gentle cleansing, warm compresses, and topical antibiotics for mild cases, and prescription oral antibiotics for moderate to severe cases, as recommended by the most recent guidelines 1. The treatment approach for folliculitis involves addressing the underlying cause of the infection, which is usually bacterial, and reducing inflammation in the hair follicles.
- For mild cases, start with gentle cleansing using antibacterial soap twice daily,
- warm compresses to reduce inflammation,
- and avoiding tight clothing that causes friction. Over-the-counter treatments include
- benzoyl peroxide 2.5-5% wash or cream applied once or twice daily,
- or topical antibiotics like clindamycin 1% solution. For moderate to severe cases, prescription treatments are necessary, such as
- oral antibiotics like doxycycline 100mg twice daily for 7-10 days,
- or cephalexin 500mg four times daily for 7-10 days, as suggested by the guidelines for skin and soft tissue infections 1. It is essential to note that the treatment should be guided by the severity of the infection and the presence of any underlying conditions, and systemic antimicrobials are usually unnecessary, unless fever or other evidence of systemic infection is present 1. To prevent recurrence, maintain good hygiene, avoid sharing personal items, wear loose-fitting clothing, and change out of sweaty clothes promptly. Severe or recurring cases should be evaluated by a healthcare provider to rule out underlying conditions or resistant infections, and eradication of staphylococcal carriage, such as with mupirocin ointment or clindamycin, may be necessary for individuals with recurrent furunculosis 1.
From the Research
Treatment Options for Folliculitis
The treatment for folliculitis can vary depending on the underlying cause and severity of the condition. Some of the treatment options include:
- Oral antibiotics, such as clindamycin and rifampicin, which have been shown to have a low success rate in achieving long-term remission 2
- Oral isotretinoin, which has been found to be the most effective treatment in folliculitis decalvans, with 90% of patients experiencing stable remission during and up to two years after cessation of treatment 2
- Topical treatments, such as 15% azelaic acid foam, which has been shown to be effective in reducing lesional erythema, inflammatory papule size, and overall folliculitis assessment 3
- Antifungal treatments, such as topical and oral ketoconazole, which are effective in treating Malassezia folliculitis, but may have a high frequency of relapse 4
- Dapsone, which has been used to treat folliculitis decalvans, with a daily dose of 25 mg being effective in maintaining long-term remission 5
- Topical tacrolimus ointment, which has been used to treat eosinophilic pustular folliculitis, resulting in rapid improvement of lesions 6
Considerations for Treatment
When considering treatment for folliculitis, it is essential to take into account the underlying cause of the condition, as well as the severity of symptoms. Treatment should be tailored to the individual patient, and may involve a combination of topical and oral medications. Additionally, maintenance therapy may be necessary to prevent relapse, as seen in the case of dapsone treatment for folliculitis decalvans 5.