RISK FACTORS: Abrasion, Injury, Nearby surgical wounds or draining, abscesses,Tight clothing, Poor hygiene, Exposure to hydrocarbons, Use of hot tubs or saunas, Immunodefi ciency, Diabetes mellitus, Lithium therapy, Wax epilation
GENERAL MEASURES :
. Cleanse areas bid with antibacterial soap (e.g. Dial)
. Shampoo daily with Selsun Blue for scalp lesions
. Apply moist heat to pustules to encourage them to drain
. For shaved areas:
. Try electric razor instead of blade, and sterilize electric razor cutting parts with alcohol for 30 minutes
daily.
. Or change blade of sharp razor daily
. Allow hair to grow.
. Avoid wax epilatories if they cause a rash.
. Avoid skin oils or greasy ointments
. Avoid topical oils
DRUG(S) OF CHOICE :
. Staphylococcal folliculitis,
. Dicloxacillin 250 mg qid
. Erythromycin 250 mg qid
. Cephalosporin
. Pseudomonas folliculitis
. Usually self limited, no antibiotic indicated
. If severe or persistent adults can use ciprofloxacin 500 mg or ofl oxacin 400 mg bid for 10 days
. Eosinophilic pustular folliculitis
. No local causative organism, no specific antibiotic
. Non-HIV related EPF often responds to oral indomethacin
. For EPF in HIV positive patients isotretinoin therapy appears to be promising
ALTERNATIVE DRUGS ;
β’ Mupirocin (Bactroban) topical therapy to affected area tid
β’ First generation cephalosporins for Staph. aureus
β’ For pseudomonas, third generation cephalosporins, aminoglycosides, or ticarcillin
PATIENT MONITORING
β’ One return visit in two weeks if symptoms abate
β’ Resistant cases should be followed every two weeks until cleared
PREVENTION/AVOIDANCE :
β’ Good personal hygiene; avoid sharing a towel or washcloth
β’ Discard any dressings carefully
β’ Avoid causative factors
β’ Find and treat family members or friends who may be a source of reinfection
POSSIBLE COMPLICATIONS : May progress to become furuncles or abscesses
EXPECTED COURSE/PROGNOSIS :
β’ Usually resolves with treatment
β’ May recur in staph carriers. Mupirocin may be required on nares of patient to treat carrier state. Family carriers may also require treatment.
β’ Resistant or severe cases may warrant testing for diabetes mellitus or immunodeficiency