BACTERIAL FOLLICULITIS

By Gary M. White, MD

Bacterial Folliculitis, Staphylococcus Multiple pustules. Note the hairs emanating from each center.


Bacterial folliculitis is a bacterial infection of the follicle. Staphylococcus aureus is the most common culprit. Bacterial culture excludes acne and pityrosporum folliculitis and directs therapy. See also bacterial folliculitis of the scalp.

Clinical

Folliculitis is an inflammation of the hair follicle. A bacterial folliculitis is a bacterial infection of the hair follicle. Staphylococcus aureus is the usual cause. Pseudomonas may infect the follicle as well in hot tub folliculitis. The classic lesion is a pustule at the site of a follicle with surrounding erythema. A hair may or may not pierce the pustule. Early lesions or deep lesions may merely appear as erythematous papules. A bacterial folliculitis is common on the legs of a young woman who shaves.

Treatment

A culture is usually done to confirm the diagnosis and direct therapy. However, therapy may be initiated before the culture is back. In general, a 10-day course of an oral antibiotic active against Staphylococcus (e.g cephalexin 250-500 QID or doxycycline 100 BID) is sufficient. Many patients will pick at the lesions, causing scarring and spreading the infection. This should be avoided. Occlusive moisturizers, cream etc should not be applied during therapy as they can clog the pores and help the folliculitis to persist. The patient should shower daily with soap (or hibiclens as noted below). Towels and clothing should be washed frequently.

Chronic, Recurrent Staphylococcal Infection

For prevention (as recurrent or chronic bacterial folliculitis can be a problem), the patient may use an antibacterial soap. Some patients with low iron can be susceptible to chronic bacterial folliculitis. The nose or a family member may be a source of the recurrent infection. Some patients with recurrent staph aureus infection may benefit from the following regimen:

  1. Oral antibiotic as directed by culture and sensitivities for 14 days (e.g., cephalexin 500 mg QID or doxycycline. Some have added rifampin 300 mg BID for the last 4 days of the 14 days).
  2. Chlorhexidine (e.g., OTC Hibiclens) as a soap in the shower, washing from the top of the head to the bottoms of the feet daily for a month, then taper as able.
  3. Bacitracin applied 1/2 to 1 inch into each nostril and around the anus daily for one month, then taper as able.
  4. Also, the patient should refrain from sharing towels or soap. Any open sores or cuts should get bacitracin and a bandage.
  5. In resistant cases, the entire family may need to do steps 2-4 (above) as they may be carriers of the staph (e.g., in their noses--one can perform nasal cultures of the entire family if needed.)

Additional Pictures

Bacterial Folliculitis, Staphylococcus Bacterial Folliculitis, Staphylococcus

Bacterial Folliculitis, Staphylococcus Bacterial Folliculitis, Staphylococcus

Staphylococcal folliculitis of the beard area mimicking acne.
Bacterial Folliculitis, Staphylococcus Bacterial Folliculitis, Staphylococcus

Bacterial folliculitis of the crown in a young male is not uncommon.
Bacterial Folliculitis, Staphylococcus Bacterial Folliculitis, Staphylococcus

The axilla is a common place for bacterial folliculitis.
Bacterial Folliculitis, Staphylococcus Bacterial Folliculitis, Staphylococcus

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