From the Guidelines
Folliculitis is best managed with a combination of topical and oral therapies, prioritizing good hygiene practices to prevent complications and promote quality of life. For mild cases, start with topical antibiotics like clindamycin 1% solution or benzoyl peroxide 5-10% wash applied to affected areas once or twice daily for 7-14 days 1. For moderate to severe cases, add oral antibiotics such as doxycycline 100mg twice daily or cephalexin 500mg four times daily for 7-10 days 1. Good hygiene practices are essential:
- wash affected areas with antibacterial soap
- avoid sharing personal items
- wear loose-fitting clothing
- change clothes after sweating Hot tubs and pools should be avoided until the infection resolves. For recurrent folliculitis, consider using chlorhexidine 4% wash or dilute bleach baths (1/4 cup bleach in a full bathtub) twice weekly. Folliculitis occurs when hair follicles become infected, most commonly by Staphylococcus aureus bacteria, though other bacteria, fungi, or viruses can be responsible 1. The infection causes inflammation of the follicles, resulting in small, red, sometimes pus-filled bumps around hair follicles. Without proper treatment, folliculitis can lead to more serious infections, scarring, or permanent hair loss. It is crucial to assess the necrotizing or non-necrotizing character of the infection, the anatomical extension, the characteristics of the infection (purulent or non-purulent), and the clinical conditions of the patient to classify patients with soft-tissue infections accurately 1.
From the Research
Folliculitis Overview
- Folliculitis is a bacterial or fungal infection of the hair follicle, which can be treated with various interventions such as topical antibiotics, topical antiseptics, systemic antibiotics, phototherapy, and incision and drainage 2.
- The condition can resolve spontaneously, but if left untreated, it may progress to boils, also known as furuncles, which can lead to cellulitis or lymphadenitis 2.
Treatment Options
- A systematic review of 18 randomized controlled trials (RCTs) found that comparative trials have not identified important differences in efficacy or safety outcomes between different oral antibiotics for treating bacterial folliculitis or boils 2.
- Topical antifungal therapy has been shown to be effective in treating Malassezia folliculitis, with beneficial results similar to those of systemic antifungal agents 3.
- Oral antifungal treatment has been found to be successful in treating Pityrosporum folliculitis, with a complete response rate of 92% 4.
- Antifungal treatment has also been found to be effective in reducing the number of lesions in patients with Malassezia folliculitis, with a decrease of 50% or more in 68.4% of patients who completed the treatment 5.
Diagnosis and Prevalence
- Malassezia folliculitis can clinically mimic acne vulgaris, and patients may receive unnecessary and prolonged antibiotic treatment 5.
- The prevalence of Malassezia folliculitis among patients with papulopustular/comedonal acne has been found to be 25.3% 5.
- Cytology can be helpful in making the correct diagnosis and providing proper management of Malassezia folliculitis 5.
- Pityrosporum folliculitis has been found to be more common in younger males, with an average age of presentation of 24.26 years 4.