What is the treatment for folliculitis?

From the Guidelines

Folliculitis can be treated with a combination of topical and oral medications, depending on severity, with the most recent guidelines recommending treatment similar to other superficial skin infections, such as impetigo, erysipelas, and cellulitis, which are managed by antibiotic therapy against Gram-positive bacteria 1. For mild cases, start with warm compresses applied to affected areas 3-4 times daily for 15-20 minutes to reduce inflammation and promote drainage. Use antibacterial soap like chlorhexidine or benzoyl peroxide washes daily. Apply over-the-counter topical antibiotics such as mupirocin 2% ointment three times daily for 7-10 days. Some key points to consider in the treatment of folliculitis include:

• For moderate to severe cases, oral antibiotics may be necessary, typically dicloxacillin 500mg four times daily or cephalexin 500mg four times daily for 7-10 days.
• If MRSA is suspected, consider trimethoprim-sulfamethoxazole (Bactrim) 1-2 tablets twice daily.
• For fungal folliculitis, use antifungal creams like ketoconazole 2% applied twice daily for 2-3 weeks.
• Prevention is crucial - maintain good hygiene, avoid sharing personal items, wear loose-fitting clothing, and change out of sweaty clothes promptly. Folliculitis occurs when hair follicles become infected, most commonly by Staphylococcus aureus bacteria, though other bacteria, fungi, or viruses can cause it, leading to inflammation of the follicle, resulting in small, red, sometimes pus-filled bumps around hair follicles, as discussed in the guidelines for the management of skin and soft-tissue infections 1.

From the FDA Drug Label

adults and children 2 years of age and older: clean the affected area apply a small amount of this product (an amount equal to the surface area of the tip of a finger) on the area 1 to 3 times daily may be covered with a sterile bandage The treatment for folliculitis is to clean the affected area and apply a small amount of bacitracin (TOP) 1 to 3 times daily, which may be covered with a sterile bandage 2.

From the Research

Treatment Options for Folliculitis

• The treatment for folliculitis may involve the use of topical antibiotics, topical antiseptics, systemic antibiotics, phototherapy, and incision and drainage 3.
• A study comparing different oral antibiotics for treating bacterial folliculitis or boils found that there may be little to no difference in clinical cure rate between cefdinir and cefalexin, and between cefditoren pivoxil and cefaclor 3.
• Another study found that oral isotretinoin was the most effective treatment in folliculitis decalvans, with 90% of patients experiencing stable remission during and up to two years after cessation of treatment 4.
• Cytology can be a useful diagnostic tool in the differential diagnosis of folliculitis, allowing for the identification of various bacterial, fungal, viral, and parasitic pathogens 5.
• In cases of EGFR inhibitor-associated acneiform folliculitis, standard acne treatments such as benzoyl peroxide, oral or topical antibacterials, and retinoic acid may provide some benefit 6.

Management of Folliculitis

• Folliculitis can be managed through recognition of its clinical manifestations, classification according to anatomical location and histopathologic patterns, and treatment based on etiology 7.
• The presence of superficial pustules does not always imply an infectious origin, and noninfectious types of folliculitis should be considered in the diagnosis 7.
• Treatment options for folliculitis may include topical and systemic antibiotics, as well as other therapies such as phototherapy and incision and drainage 3, 4, 7.