Superficial bacterial folliculitis (Bockhart impetigo) treatment
Tips
- Superficial bacterial folliculitis treatment includes warm compresses, antiseptic cleansers and antibiotics.
- Gram staining and bacterial cultures may be recommended in severe, recurrent or treatment-resistant cases.
- Diabetes, obesity, long term use of antibiotics and immunosuppression may predispose to bacterial folliculitis.
- Bacterial folliculitis may occur secondary to itchy skin diseases.
Topical treatment
Mild cases
- Antibacterial washes that contain chlorhexidine or sodium hypochlorite.
- Antiseptic cleansers.
Localized folliculitis
- Topical antibiotics such as mupirocin, clindamycin, erythromycin, retapamulin ointment or Fusidic acid may also be used for 7–10 days to treat localized lesions.
Widespread folliculitis
- Cephalexin
- 250 to 500 mg four times per day for adults.
- 25–50 mg/kg/day 4 divided doses PO for children.
- Dicloxacillin
- 250 to 500 mg 4 times per day for adults.
- 25–50 mg/kg/day in 4 divided doses PO for children.
- Oral trimethoprim/sulfamethoxazole
- 1–2 double strength tablets bid PO for adults.
- 8–12 mg/kg (based on trimethoprim component) in either 4 divided doses IV or 2 divided doses PO.
- Clindamycin
- 300 to 450 mg four times per day PO or 25–40 mg/kg/day in 3 divided doses IV for adults.
- 25–40 mg/kg/day in 3 divided doses IV or 25–30 mg/kg/day in 3 divided doses PO for children.
- Doxycycline : 100 mg twice daily ( Not recommended for age <8 yrs).
Recurrent cases prophylaxis
- Mupirocin 2% ointment twice daily to the nares for 5–10 days can be used to eradicate nasal carriage of S. aureus.
- Decolonize the skin (e.g. axillae, perineum/ groin, sub mammary area) using topical mupirocin, washes containing chlorhexidine or triclosan.
- Dilute sodium hypochlorite baths (e.g. 0.5 cup household bleach [6–8.25% sodium hypochlorite] in a full standard bathtub).
- Rifampin at 600 mg/d orally for 10 days may eliminate the carrier state.
References
Dermatology , Edited by Jean L. Bolognia , Julie V. Schaffer , Lorenzo Cerroni Fourth edition: Elsevier, 2018, ISBN 978–0‐7020–6275–9.
Griffiths, C., Barker, J., Bleiker, T. O., Chalmers, R., & Creamer, D. (Eds.). (2016). Rook’s textbook of dermatology. John Wiley & Sons.
Mashhood, A. A., Shaikh, Z. I., Qureshi, S. M., & Malik, S. M. (2006). Efficacy of rifampicin in eradication of carrier state of Staphylococcus aureus in anterior nares with recurrent furunculosis. Journal of the College of Physicians and Surgeons–Pakistan: JCPSP, 16(6), 396-399.
https://emedicine.medscape.com/