eMedicine Specialties > Dermatology > Bacterial Infections

Pseudomonas Folliculitis: Treatment & Medication

Author: Charles B Toner, MD, Assistant Professor, Department of Dermatology, Uniformed Services University of the Health Sciences; Mohs Micrographic Surgeon, Consultant, Charles County Dermatology, Maryland, and Georgia Dermatology & Skin Cancer Center
Coauthor(s): Stephen J Krivda, MD, Assistant Professor of Dermatology, Uniformed Services University of the Health Sciences; Chief of the Integrated Department of Dermatology, Chief of Dermatology Service, Director of Dermatopathology, Staff Dermatopathologist, Walter Reed Army Medical Center; Head, Department of Dermatology, Staff Dermatologist and Dermatopathologist, National Naval Medical
Contributor Information and Disclosures

Updated: Jun 18, 2009

Treatment

Medical Care

P aeruginosa is usually a self-limited infection, clearing in 2-10 days. Despite the discomfort caused by the Pseudomonas folliculitis rash, no treatment is necessary. Systemic spread is typically not observed.

  • P aeruginosa is resistant to nearly all common topical and oral antibiotics, and no indication exists that the course of the skin condition is altered with treatment.
  • Symptomatic relief of Pseudomonas folliculitis may be achieved through the use of acetic acid 5% compresses for 20 minutes twice a day to 4 times a day.
  • In Pseudomonas folliculitis patients with associated mastitis, in those with persistent infections, or in those who are immunosuppressed, a course of ciprofloxacin (500 or 750 mg PO bid) is advised.

Medication

Systemic antibacterials for uncomplicated Pseudomonas folliculitis infections have shown no benefit. Persistent infections may benefit from a standard 7- to 10-day course of ciprofloxacin.

Antibacterials

Bactericidal antibacterials inhibit bacterial growth and proliferation.


Ciprofloxacin (Cipro)

Member of fluoroquinolone family of synthetic, broad-spectrum antibacterials. Contains piperazine moiety responsible for antipseudomonal activity. Interferes with DNA gyrase normally needed for synthesis of bacterial DNA.

Adult

Severe infection: 750 mg PO bid for 7-14 d
Mild-to-moderate infection: 500 mg PO q12h for 7-14 d

Pediatric

<18 years: Not recommended
>18 years: Administer as in adults

Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; reduces therapeutic effects of phenytoin; probenecid may increase serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT); food delays absorption, resulting in peak concentrations closer to 2 h after dosing rather than 1 h; however, overall absorption is not substantially affected; dairy products (eg, milk, yogurt) reduce absorption (avoid concurrent use)
Antidiabetic agents, antiarrhythmic agents, CYP1A2 metabolized drugs, methotrexate, and metoprolol

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy; phototoxicity may occur with exposure to sunlight
Fluoroquinolones are associated with an increased risk of tendinitis and tendon rupture in persons of all ages; risk is further increased in older patients (usually >60 y), those taking corticosteroids, and those with kidney, heart, or lung transplants

More on Pseudomonas Folliculitis

Overview: Pseudomonas Folliculitis
Differential Diagnoses & Workup: Pseudomonas Folliculitis
Treatment & Medication: Pseudomonas Folliculitis
Follow-up: Pseudomonas Folliculitis
Multimedia: Pseudomonas Folliculitis
References
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References

  1. Gregory DW, Schaffner W. Pseudomonas infections associated with hot tubs and other environments. Infect Dis Clin North Am. Sep 1987;1(3):635-48. [Medline].

  2. Highsmith AK, Le PN, Khabbaz RF, Munn VP. Characteristics of Pseudomonas aeruginosa isolated from whirlpools and bathers. Infect Control. Oct 1985;6(10):407-12. [Medline].

  3. McCausland WJ. Pseudomonas aeruginosa rash associated with whirlpool. JAMA. Nov 29 1976;236(22):2490-1. [Medline].

  4. Price D, Ahearn DG. Incidence and persistence of Pseudomonas aeruginosa in whirlpools. J Clin Microbiol. Sep 1988;26(9):1650-4. [Medline].

  5. Ratnam S, Hogan K, March SB, Butler RW. Whirlpool-associated folliculitis caused by Pseudomonas aeruginosa: report of an outbreak and review. J Clin Microbiol. Mar 1986;23(3):655-9. [Medline].

  6. Rose HD, Franson TR, Sheth NK, Chusid MJ, Macher AM, Zeirdt CH. Pseudomonas pneumonia associated with use of a home whirlpool spa. JAMA. Oct 21 1983;250(15):2027-9. [Medline].

  7. Jacobson JA. Pool-associated Pseudomonas aeruginosa dermatitis and other bathing-associated infections. Infect Control. Oct 1985;6(10):398-401. [Medline].

  8. Lacour JP, el Baze P, Castanet J, Dubois D, Poudenx M, Ortonne JP. Diving suit dermatitis caused by Pseudomonas aeruginosa: two cases. J Am Acad Dermatol. Dec 1994;31(6):1055-6. [Medline].

  9. Saltzer KR, Schutzer PJ, Weinberg JM, Tangoren IA, Spiers EM. Diving suit dermatitis: a manifestation of Pseudomonas folliculitis. Cutis. May 1997;59(5):245-6. [Medline].

  10. Bottone EJ, Perez AA 2nd, Oeser JL. Loofah sponges as reservoirs and vehicles in the transmission of potentially pathogenic bacterial species to human skin. J Clin Microbiol. Feb 1994;32(2):469-72. [Medline].

  11. Frenkel LM. Pseudomonas folliculitis from sponges promoted as beauty aids. J Clin Microbiol. Oct 1993;31(10):2838. [Medline].

  12. Maniatis AN, Karkavitsas C, Maniatis NA, Tsiftsakis E, Genimata V, Legakis NJ. Pseudomonas aeruginosa folliculitis due to non-O:11 serogroups: acquisition through use of contaminated synthetic sponges. Clin Infect Dis. Aug 1995;21(2):437-9. [Medline].

  13. Böni R, Nehrhoff B. Treatment of gram-negative folliculitis in patients with acne. Am J Clin Dermatol. 2003;4(4):273-6. [Medline].

  14. Berger RS, Seifert MR. Whirlpool folliculitis: a review of its cause, treatment, and prevention. Cutis. Feb 1990;45(2):97-8. [Medline].

  15. Agger WA, Mardan A. Pseudomonas aeruginosa infections of intact skin. Clin Infect Dis. Feb 1995;20(2):302-8. [Medline].

  16. Ratnam S, Hogan K, March SB, Butler RW. Whirlpool-associated folliculitis caused by Pseudomonas aeruginosa: report of an outbreak and review. J Clin Microbiol. Mar 1986;23(3):655-9. [Medline].

  17. Evans MR, Wilkinson EJ, Jones R, Mathias K, Lenartowicz P. Presumed Pseudomonas folliculitis outbreak in children following an outdoor games event. Commun Dis Public Health. Apr 2003;6(1):18-21. [Medline].

  18. Fox AB, Hambrick GW Jr. Recreationally associated Pseudomonas aeruginosa folliculitis. Report of an epidemic. Arch Dermatol. Oct 1984;120(10):1304-7. [Medline].

  19. Yu Y, Cheng AS, Wang L, Dunne WM, Bayliss SJ. Hot tub folliculitis or hot hand-foot syndrome caused by Pseudomonas aeruginosa. J Am Acad Dermatol. Oct 2007;57(4):596-600. [Medline].

  20. Gustafson TL, Band JD, Hutcheson RH Jr, Schaffner W. Pseudomonas folliculitis: an outbreak and review. Rev Infect Dis. Jan-Feb 1983;5(1):1-8. [Medline].

  21. Malterud K, Thesen J. [Whirlpool and pseudomonas infection--a local outbreak]. Tidsskr Nor Laegeforen. Jun 28 2007;127(13):1779-81. [Medline].

  22. MMWR. An outbreak of Pseudomonas folliculitis associated with a waterslide--Utah. MMWR Morb Mortal Wkly Rep. Aug 19 1983;32(32):425-7. [Medline].

  23. Tate D, Mawer S, Newton A. Outbreak of Pseudomonas aeruginosa folliculitis associated with a swimming pool inflatable. Epidemiol Infect. Apr 2003;130(2):187-92. [Medline].

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Further Reading

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Keywords

Pseudomonas folliculitis, pseudomonal folliculitis Pseudomonas aeruginosa folliculitis, whirlpool folliculitis, spa pool folliculitis, hot tub folliculitis, gram-negative folliculitis

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Contributor Information and Disclosures

Author

Charles B Toner, MD, Assistant Professor, Department of Dermatology, Uniformed Services University of the Health Sciences; Mohs Micrographic Surgeon, Consultant, Charles County Dermatology, Maryland, and Georgia Dermatology & Skin Cancer Center
Charles B Toner, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Medical Association, American Society for Dermatologic Surgery, Association of Military Dermatologists, and Association of Military Surgeons of the US
Disclosure: Nothing to disclose.

Coauthor(s)

Stephen J Krivda, MD, Assistant Professor of Dermatology, Uniformed Services University of the Health Sciences; Chief of the Integrated Department of Dermatology, Chief of Dermatology Service, Director of Dermatopathology, Staff Dermatopathologist, Walter Reed Army Medical Center; Head, Department of Dermatology, Staff Dermatologist and Dermatopathologist, National Naval Medical
Stephen J Krivda, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Leonard Sperling, MD, Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences
Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory
Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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