Treatment of Infected Ingrown Hair on the Labia
For an infected ingrown hair (folliculitis or small abscess) on the labia, incision and drainage is the primary treatment, with antibiotics reserved only for cases with significant surrounding cellulitis (>5 cm of erythema) or systemic signs of infection. 1
Primary Treatment Approach
Incision and drainage alone is sufficient for most cases without antibiotics. The most important therapy is to open the infected area, evacuate the purulent material, and continue dressing changes until the wound heals by secondary intention. 1
When Antibiotics Are NOT Needed
Antibiotics are unnecessary if the patient has: 1
- Less than 5 cm of surrounding erythema and induration
- Temperature <38.5°C
- White blood cell count <12,000 cells/µL
- Pulse <100 beats/minute
Studies of subcutaneous abscesses have found little or no benefit for antibiotics when combined with adequate drainage. 1
When Antibiotics ARE Indicated
A short course (24-48 hours) of antibiotics should be added if: 1
- Temperature >38.5°C
- Heart rate >110 beats/minute
- Erythema extending beyond 5 cm from the wound margins
Antibiotic Selection (When Required)
For simple skin and soft tissue infections in the genital area, empiric coverage should target Staphylococcus aureus (including community-acquired MRSA) and Streptococcus species, as these are the most common pathogens in clean procedures not involving mucosal surfaces. 1
Recommended oral regimens include:
- Agents with MRSA coverage (trimethoprim-sulfamethoxazole, doxycycline, or clindamycin)
- Duration: 5-7 days if antibiotics are used
Important Caveats
Do not confuse this with pediculosis pubis (pubic lice). If the patient presents with pruritus and visible lice or nits on pubic hair, this requires topical pediculicide treatment (permethrin 1% cream rinse or pyrethrins with piperonyl butoxide), not antibiotics. 1, 2, 3
Prophylactic antibiotics are not recommended for incision and drainage of superficial abscesses, as this procedure rarely causes bacteremia. 1
Adjunctive Measures
- Cleanse the wound with sterile normal saline (iodine or antibiotic solutions are unnecessary) 1
- Elevation of the affected area accelerates healing if swelling is present 1
- Infected wounds should not be closed primarily 1
Follow-Up
Patients should be re-evaluated if symptoms persist or worsen after 24-48 hours of appropriate treatment. 1