Medication Summary
Topical antibiotics can be used as first-line agents in cases of recurrent superficial folliculitis. If a patient has widespread involvement, persistent lesions, or if a deep infection is present, systemic antibiotics may then be indicated. The drug of choice must cover penicillin-resistant S aureus or, in some situations, methicillin-resistant S aureus.
Antibiotics, Other
Class Summary
For patients who do not respond to standard antimicrobial treatments, therapy should be guided by culture sensitivity.
Clindamycin, topical (Cleocin, Cleocin T, ClindaMax, Clindagel, Evocin)
Clindamycin topical solution is a lincosamide for the treatment of serious skin and soft tissue staphylococcal infections. It is also effective against aerobic and anaerobic streptococci (except enterococci). It inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Mupirocin (Bactroban, Centany)
Mupirocin is the drug of choice for localized disease; it inhibits bacterial growth by inhibiting RNA and protein synthesis.
Cephalexin (Keflex)
Cephalexin is a first-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell wall synthesis. It has bactericidal activity against rapidly growing organisms. It has primary activity against skin flora and is used for skin infections or prophylaxis in minor procedures.
Although cephalosporins have significant staphylococcal coverage in most populations, coverage of Pasteurella species is not as good as amoxicillin and clavulanate.
Dicloxacillin
Dicloxacillin is for the treatment of infections caused by penicillinase-producing staphylococci. It may be used to initiate therapy when staphylococcal infection is suspected.
Erythromycin topical (Akne-mycin, Ery)
Erythromycin inhibits bacterial growth, possibly by blocking the dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is used for the treatment of staphylococcal and streptococcal infections. This topical solution (2%) is indicated for infections caused by susceptible strains of microorganisms.
Minocycline (Minocin, Dynacin, Solodyn)
Minocycline is not the drug of choice for staphylococcal infection. It treats infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma species. Minocycline was found to be effective in some nontuberculotic mycobacterial infections.
Rifampin (Rifadin)
Rifampin is for use in combination with at least one other anti-TB drug. It inhibits DNA-dependent bacterial RNA polymerase but not mammalian RNA polymerase. Cross-resistance may occur. Treat for 6-9 months or until 6 months have elapsed from conversion to sputum culture negativity.
Ciprofloxacin (Cipro)
Ciprofloxacin inhibits DNA gyrase and topoisomerase IV for bactericidal activity. Use it as an alternative for MRSA infection.
Trimethoprim and sulfamethoxazole (Bactrim, Bactrim DS, Septra DS)
Trimethoprim/sulfamethoxazole inhibits bacterial growth by inhibiting the synthesis of dihydrofolic acid. The antibacterial activity of trimethoprim/sulfamethoxazole includes common urinary tract pathogens, except Pseudomonas aeruginosa.
Linezolid (Zyvox)
Linezolid binds to the 50S ribosomal subunit, interfering with protein synthesis. This agent is used for MRSA or complicated skin infections.
Dapsone (Aczone)
Dapsone prevents bacterial use of para-aminobenzoic acid (PABA) for folic acid synthesis by acting as a competitive inhibitor. It is used in the treatment of eosinophilic pustular folliculitis.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Class Summary
Because the etiology and the pathogenesis of eosinophilic pustular folliculitis have not been fully elucidated, no established treatment schemes exist. A number of options have been tried with various results; however, no controlled treatment trials have been performed for this condition. Oral indomethacin consistently appears to be most beneficial, at least in the classic form of the disease.
Indomethacin (Indocin)
Indomethacin is a potent inhibitor of cyclooxygenase, which may decrease the local production of arachidonic acid–derived chemotactic factors for eosinophils present in sebum (eg, 12-L-hydroxy-5,8,10-heptadecatrienoic acid and/or prostaglandin).
Antifungals, Other
Class Summary
Many topical antifungal preparations are available to treat the forms of folliculitis (eg, tinea barbae, Pityrosporum folliculitis) caused by fungus. Topical agents should be active against dermatophytes.
Antifungals are used in the first-line therapy of Pityrosporum folliculitis. The use of topical agents has few adverse effects besides an allergic reaction to the active agent or inactive component. The mechanism of action usually involves the inhibition of pathways (eg, enzyme, substrate, transport) that are necessary for sterol and/or cell membrane synthesis, or the permeability of the cell membrane (polyenes) of the fungal cell is altered.
Ciclopirox (Loprox)
Ciclopirox interferes with DNA, RNA, and protein synthesis by inhibiting the transport of essential elements in fungal cells.
Econazole topical (Ecoza)
Econazole is effective in cutaneous infections. It interferes with RNA and protein synthesis and metabolism. It disrupts fungal cell wall permeability, causing fungal cell death.
Ketoconazole (Nizoral, Xolegel, Extina)
Ketoconazole is an imidazole broad-spectrum antifungal agent. It inhibits the synthesis of ergosterol, causing cellular components to leak, resulting in fungal death.
Antivirals, Other
Class Summary
These agents are inhibitors of DNA polymerase in HSV-1 and HSV-2 strains, inhibiting viral replication. They are used in folliculitis secondary to herpes viral infections.
Famciclovir (Famvir)
Famciclovir is a prodrug that, when biotransformed into the active metabolite penciclovir, may inhibit viral DNA synthesis/replication.
Valacyclovir (Valtrex)
Valacyclovir is a prodrug that is rapidly converted to the active drug acyclovir. It is more expensive than acyclovir, but its dosing regimen is more convenient.
Acyclovir (AHydrocort, Alphosyl, Aquacort)
Acyclovir has an affinity for viral thymidine kinase and, once phosphorylated, causes DNA chain termination when acted upon by DNA polymerase. The drug, which requires 5 daily doses, can be associated with compliance problems.
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A 22-month-old boy with a staphylococcal folliculitis on the buttocks. The lesions have been excoriated. Diaper occlusion may have been related to onset of the rash.
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A 30-year-old woman with hot tub folliculitis. She had used a hot tub 2 days prior, wearing a bikini-style bathing suit.
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Pseudomonas folliculitis. Courtesy of Hon Pak, MD.
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Superficial folliculitis with neutrophils concentrated in the upper aspect of the follicle
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Perifolliculitis, showing inflammatory cells surrounding the follicle,
