Folliculitis (cont.)
What are possible complications of folliculitis?
Complications are infrequent since folliculitis is usually a self-limited
skin condition. Rarely, the infected bumps may enlarge, causing an abscess
(furuncles or carbuncles) or painful cysts requiring minor surgical drainage.
Deeper or more extensive skin infections called cellulitis can be a rare
complication.
Another potential complication includes temporary skin discoloration called
post-inflammatory hypopigmentation (lighter than the regular skin color) or
hyperpigmentation (darker then the regular skin color). This altered skin color
may occur after the inflamed red bumps have improved or after a temporary
flare.
Permanent scarring in uncommon but may occur from picking, overly aggressive
scrubbing, or other deep inflammation.
How is folliculitis treated?
There are many treatment options and skin care recipes for treating
folliculitis. The specific treatment depends on the cause of the folliculitis.
Home therapy for mild cases of bacterial folliculitis includes use of an over-the-counter antibacterial wash like benzoyl peroxide (Clearisil, Proactiv),
chlorhexidine (Hibiclens), or Phisoderm twice a day. The best results may be
achieved with combination therapy using topical products and antibacterial
washes.
Holistic treatment for folliculitis may include soaking the affected area in
a tub of diluted white vinegar (1 part vinegar to 4 parts of water) or soaking in
a bathtub with very diluted Clorox bleach (¼ cup of Clorox bleach in a
bathtub full of water).
Bacterial folliculitis may be treated with antibacterial skin washes and
topical and/or oral antibiotics. It is important to keep in mind that as with
any condition, no therapy is uniformly effective in all people. Your doctor may
need to help evaluate the cause of your folliculitis
Moderate cases of bacterial folliculitis may be treated by a routine of
twice-daily application of a topical antibiotic, such as clindamycin lotion or
metronidazole lotion. A five- to 30-day course of an oral antibiotic like cephalexin,
dicloxacillin, doxycyline, minocycline, tetracycline, ciprofloxacin, or
levofloxacin may be used for folliculitis that is more resistant. After initial
clearing with stronger medications, a milder maintenance antibacterial wash
and topical antibiotic may be recommended.
Treatment of folliculitis associated with dry skin should address the
underlying dryness. General measures to prevent excessive skin dryness and
breakdown such as using mild soapless cleansers are recommended for these
cases. Lubrication with moisturizer lotions such as Cetaphil or Lubriderm is
helpful for many. Additional available therapeutic options for tougher cases of
dry skin include lactic-acid lotions (AmLactin, Lac-Hydrin), alpha hydroxy acid
lotions (glytone, glycolic body lotions), urea cream (Carmol 10, Carmol 20,
Carmol 40, Urix 40), and salicylic acid (Salex lotion).
Occasionally, physicians may prescribe a short seven- to 10-day course of a medium
potency, emollient-based topical steroid cream like triamcinolone once or twice
a day for inflamed or itchy areas. Inflammatory folliculitis may also be treated
with topical steroids and/or immunomodulators like Elidel or Protopic. Although
these creams are approved for atopic dermatitis and eczema, their use would be
considered "off label" (non-FDA labeled use) for folliculitis. These may be used
in more resistant cases where there is considerable skin redness or
inflammation.
Fungal or yeast folliculitis is often treated with an antifungal shampoo or
body wash such as ketoconazole (Nizoral shampoo) twice daily. More resistant or
deeper fungal folliculitis may require the addition of a topical antifungal
cream such as lotrimin or terbinafine (Lamisil) and an antifungal pill such as
fluconazole (Diflucan).
Persistent skin discoloration called hyperpigmentation may be treated with
prescription fading creams like hydroquinone 4%, kojic acid, and azelaic acid
15%-20%. Over-the-counter fading creams with 2% hydroquinone may be available
like Porcelana. Specially designed prescription creams for particularly
resistant skin discoloration using higher concentrations of hydroquinone 6%, 8%,
and 10% may also be formulated by compounding pharmacists.
Severe cases of folliculitis and acne have been treated with isotretinoin (Accutane)
pills for several months. Accutane is generally a very potent oral medication
reserved for severe, resistant, or scarring cases of acne. Its use in
folliculitis would be considered off- label (not FDA approved) and not routine.
Next: How do I prevent folliculitis? »
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