By Gary M. White, MD
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.
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.
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.
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:
Staphylococcal folliculitis of the beard area mimicking acne.
Bacterial folliculitis of the crown in a young male is not uncommon.
The axilla is a common place for bacterial folliculitis.
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