Treatment for Folliculitis
The recommended treatment for folliculitis includes using gentle pH-neutral soaps with tepid water, keeping the affected area clean and dry, wearing loose-fitting cotton clothing, and considering topical or oral antibiotics based on severity, with tetracyclines being particularly effective for their anti-inflammatory and antimicrobial properties. 1
Initial Management Approach
- Use gentle pH-neutral soaps and tepid water for cleansing the affected area, pat the skin dry after showering, and wear loose-fitting, fine cotton clothing to reduce friction and moisture 2, 1
- Avoid greasy creams as they might facilitate the development of folliculitis due to their occlusive properties 2
- Avoid manipulation of skin in the affected area to reduce the risk of secondary infection 2
- For mild cases, topical antibiotics or antiseptics may be sufficient to control the infection 1
Moderate to Severe Cases
- For widespread folliculitis or cases with systemic symptoms, oral antibiotics should be considered 1
- Tetracyclines (doxycycline, minocycline) are particularly effective due to their dual anti-inflammatory and antimicrobial effects 2, 1
- For suspected or confirmed Staphylococcus aureus infection with systemic symptoms, antibiotics active against MRSA may be necessary 1
- Bacterial swabs should be taken if secondary infection occurs, as Staphylococcus aureus is the most frequently detected infectious agent 2
- Incision and drainage is recommended for large furuncles or abscesses 1
For Recurrent Folliculitis
- Search for local causes such as hidradenitis suppurativa or foreign material 1
- Consider a 5-day decolonization regimen with intranasal mupirocin, daily chlorhexidine washes, and decontamination of personal items 1
- Culture recurrent abscesses and treat with a 5-10 day course of an antibiotic active against the isolated pathogen 1
- For refractory cases, oral isotretinoin should be considered, especially in cases with mild active disease (perifollicular erythema and hyperkeratosis without pustules or crusts) 3
Special Considerations for Specific Types of Folliculitis
- For fungal folliculitis (e.g., Candida), oral antifungals such as ketoconazole and topical antifungal agents like econazole may be effective 4
- For folliculitis decalvans (a form of scarring alopecia), oral antibiotics are recommended for moderate to severe inflammation, with oral isotretinoin as first-line therapy for mild active disease 3
- In highly active folliculitis decalvans, a short course of oral glucocorticosteroids may be beneficial 3
Adjunctive Treatments
- Topical or intralesional corticosteroids of mild to moderate potency can be used for short-term reduction of inflammation 1
- Topical tacrolimus 0.1% or dapsone 5% may be considered as second-line topical therapeutic options for certain types of folliculitis 3
- For refractory cases of folliculitis decalvans, photodynamic therapy, biologics (preferably adalimumab), JAK inhibitors, oral dapsone, hydroxychloroquine, or cyclosporine may be effective 3
Common Pitfalls to Avoid
- Avoid using topical acne medications without dermatologist supervision, as they may irritate and worsen the condition 2
- Avoid prolonged use of topical steroids as they may cause skin atrophy, striae, telangiectasia, and purpura if used inadequately 2
- Avoid hot blow-drying of hair and tight shoes, which can exacerbate folliculitis 2
- Don't assume all folliculitis is bacterial; consider fungal, viral, and non-infectious causes, especially in treatment-resistant cases 5, 6