9.6 Folliculitis
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Folliculitis – uncomplicated superficial | Topical Mupirocin Or Topical Fusidic acid Duration based on clinical response | Oral antibiotics if multiple lesions present • Amoxicillin 500mg TDS (25-50mg/kg/day) • Cloxacillin 500mg QID (50mg/kg/day) • Cephalexin 250-500mg QID (25–50 mg/kg/day) • Cefadroxil 500 mg q12h • Amoxicillin- clavulanate combination: 625mg TDS Duration: 3 to 5 days based on clinical response | Non-infectious causes of folliculitis include: excessive use of oils (especially in hot humid season), waxing, epilation, occlusive dressings, etc. In case of recurrent lesions, look for nasal Staphylococcus carriage. Simple cases of Gram- negative folliculitis, Staphylococcal folliculitis, will generally resolve spontaneously after 7 to 10 days with good skin hygiene. A large furuncle may also require drainage. |
| Furuncle and carbuncle | |||
| Gram Negative folliculitis – Not responding to regular acne management | Trimethoprim- Sulfamethoxazole DS (800+160) q12h for 10- 14 days | Amoxicillin 500mg TDS (25-50 mg/kg/day) for 7-10 days | |
| Pityrosporum Folliculitis | Itraconazole 100- 200mg/day for 3 weeks Or Fluconazole 100- 200mg/day for 1-2 weeks* | ||
| Demodex Folliculitis | Topical Permethrin + Metronidazole 400mg q12h Duration based on clinical response; may range from weeks to months. | ||
| Eosinophilic folliculitis | Topical corticosteroids, antihistamines, phototherapy, and Itraconazole 100- 200mg/day for 3 weeks | In patients with eosinophilic folliculitis, HIV should be ruled out. First-line treatment for this condition is antiretroviral therapy. |
For common etiological agents of Folliculitis, see Annexure B.9.6
References
1. Jacob S, VanDaele MA, Brown JN. Treatment of Demodex-associated inflammatory skin conditions: A systematic review. Dermatol Ther. 2019 Nov;32(6): e13103. doi: 10.1111/dth.13103. Epub 2019 Oct 28. PMID: 31583801.
2. 2. IDSA 2014: Clinical Practice Algorithm for management of skin and soft tissue infections: Dennis L. Stevens, Alan L. Bisno, Henry F. Chambers, E. Patchen Dellinger, Ellie J. C. Goldstein, Sherwood L. Gorbach, Jan V. Hirschmann, Sheldon L. Kaplan, Jose G. Montoya, James C. Wade, Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 59, Issue 2, 15 July 2014, Pages e10–e52, https://doi.org/10.1093/cid/ciu296