Treatment of Folliculitis in Pediatric Patients
For pediatric patients with folliculitis, topical clindamycin 1% solution/gel applied twice daily is the recommended first-line treatment for mild cases. 1
Initial Assessment and Management
- Gentle pH-neutral soaps and tepid water should be used for cleansing the affected area, followed by patting the skin dry and wearing loose-fitting clothing to reduce friction and moisture 1
- Avoid greasy creams in the affected area and manipulation of the skin to reduce risk of secondary infection 1
- Laboratory investigations to confirm the diagnosis may be advisable to isolate the causal organism and direct the choice of therapy 1
Topical Treatment Options
- Topical clindamycin 1% solution/gel applied twice daily is effective for mild cases of folliculitis 1
- Mupirocin 2% topical ointment can be applied three times daily for 7-10 days to prevent secondary bacterial infection 2
- Chlorhexidine antiseptic washes can be used as an adjunctive therapy to help prevent infection 2
- Topical corticosteroids of mild to moderate potency can be used short-term to reduce inflammation, but prolonged use should be avoided as they may cause skin atrophy or even worsen folliculitis 1
Systemic Treatment Options
- For moderate to severe cases or widespread disease, oral doxycycline is recommended for patients 8 years and older 3, 1
- For children under 8 years of age, tetracyclines should be avoided due to risk of dental staining 2
- For patients with doxycycline intolerance, oral minocycline can be used for patients 8 years and older 3
- For suspected or confirmed Staphylococcus aureus infection with systemic symptoms, combination therapy with oral rifampin and clindamycin may be effective 3, 1
Management of Recurrent or Refractory Folliculitis
- A 5-day decolonization regimen with intranasal mupirocin, daily chlorhexidine washes, and decontamination of personal items should be considered for recurrent cases 1
- Culture recurrent lesions and treat with antibiotics active against the isolated pathogen 1
- For large furuncles or abscesses, incision and drainage is recommended 1, 4
- Diluted bleach baths (1 teaspoon per gallon of bath water for 15 minutes twice weekly) may be considered for patients with recurrent skin infections 2
Special Considerations for Pediatric Patients
- Safety and effectiveness of many topical antibiotics have not been established in children under 12 years of age 3
- For intralesional steroid injections in pediatric patients, consider the patient's age and procedural tolerance, and use appropriate pain management and distraction techniques 3
- For extensive areas of erosion, antiseptics such as potassium permanganate baths or antiseptic-containing bath oils may help dry lesions and prevent infection 2
Common Pitfalls to Avoid
- Topical acne medications should not be used without dermatologist supervision as they may irritate and worsen the condition 1
- Prolonged use of topical steroids should be avoided as they may cause skin atrophy 1
- Folliculitis is a common side-effect of treatment with potent topical steroids, so monitor closely when using these agents 1
- Differential diagnoses such as tinea capitis should not be missed, as it can present with diffuse pustular lesions resembling folliculitis 1
Monitoring and Follow-up
- Monitor for signs of increasing erythema, warmth, pain, or purulent drainage that may indicate secondary infection requiring systemic antibiotics 2
- Consider obtaining bacterial cultures if infection is suspected or if there is inadequate response to initial topical therapy 2
- Blisters should generally be left intact when possible to prevent secondary bacterial infection 2