Treatment of Infected Ingrown Hair
For an infected ingrown hair that is becoming red, incision and drainage is the primary treatment, and antibiotics are typically unnecessary unless systemic signs of infection are present. 1
When Antibiotics Are NOT Needed
Most inflamed hair follicles (furuncles) and small abscesses do not require systemic antibiotics. 1 The key treatment approach is:
- Incision and drainage is recommended for large furuncles and abscesses 1
- Small furuncles often rupture and drain spontaneously or with moist heat application 1
- Simply covering the surgical site with a dry dressing after drainage is usually the most effective treatment 1
When Antibiotics ARE Indicated
The decision to prescribe antibiotics should be based on the presence of systemic inflammatory response syndrome (SIRS), which includes: 1
- Temperature >38°C or <36°C
- Tachycardia >90 beats per minute
- Tachypnea >24 breaths per minute
- White blood cell count >12,000 or <400 cells/µL
Antibiotic Selection When Treatment Is Required
For Mild Infection WITH Systemic Signs:
First-line oral antibiotics active against Staphylococcus aureus: 1
- Cephalexin 500 mg four times daily 1
- Dicloxacillin 500 mg four times daily 1
- Clindamycin 300-450 mg three to four times daily 1
If MRSA is Suspected or Confirmed:
Consider MRSA coverage if the patient has: 1
- Failed initial antibiotic treatment
- Markedly impaired host defenses
- Known MRSA colonization
- Injection drug use history
MRSA-active oral options: 1
- Trimethoprim-sulfamethoxazole 1-2 double-strength tablets twice daily 1
- Doxycycline 100 mg twice daily 1
- Clindamycin 300-450 mg four times daily (if local resistance patterns allow) 1
Treatment Duration:
5-10 days of antibiotic therapy is recommended 1
Topical Treatment Option
For very limited superficial infections without systemic signs, topical mupirocin ointment applied three times daily may be considered as an alternative to oral antibiotics. 1, 2 Mupirocin has excellent activity against staphylococci and streptococci with clinical cure rates of 71-93% in skin infections. 2, 3, 4
Important Clinical Pitfalls
- Do not prescribe antibiotics for simple folliculitis or small furuncles without systemic signs - this promotes unnecessary antibiotic resistance 1
- Culture the lesion if it recurs to guide targeted antibiotic therapy 1
- Gram stain and culture are recommended for carbuncles and abscesses but not routinely needed for simple furuncles 1
- For recurrent infections, consider a 5-day decolonization regimen with intranasal mupirocin twice daily, daily chlorhexidine washes, and decontamination of personal items 1