All About Gram-Negative Folliculitis

Gram-negative folliculitis is a type of acne complication that usually occurs after prolonged treatment with antibiotics. Acne vulgaris, which causes whiteheads, blackheads, pimples and pustules, occurs when dirt, bacteria, oil and dead skin cells clog the pores. When acne is not controlled by over-the-counter treatments, a physician may prescribe an antibiotic such as doxycycline to reduce the amount of bacteria on the skin. This treatment also affects the number of bacterial organisms present in the nasal passages. Gram-negative organisms usually make up only 1 percent of a person’s nasal flora. In people who use antibiotics to treat acne, gram-negative organisms make up as much as 4 percent of the nasal flora. In some people, the gram-negative organisms leave the nasal passages and come into contact with the skin on the face.

Signs and Symptoms

The signs and symptoms of folliculitis depend on the extent of the problem. Superficial folliculitis only affects the upper part of each hair follicle. This type of gram-negative folliculitis causes red skin, inflamed skin, tenderness, itching, clusters of red bumps around the hair follicles and the formation of pus-filled blisters. Deep folliculitis gets deeper in the skin and affects the entire hair follicle. This condition causes pain, large bumps and pus-filled blisters. Once the infection clears, this type of folliculitis may leave permanent scars. Doctors can usually diagnose this condition just by looking at the skin, but some might take a sample of liquid from one of the pustules on the skin and have it tested in a laboratory. This can help determine exactly which bacteria is causing the problem.


It may not be entirely possible to prevent folliculitis, but those who use antibiotics to treat acne should try to protect themselves. Men who save their faces should use a new blade each time they shave. Avoiding cuts and nicks can prevent bacteria from building up on the face. If shaving seems to make things worse, avoiding shaving until the infection clears up can give the skin a much-needed break.

Treatment Options

Drug therapy is the best way to treat gram-negative folliculitis, as topical treatment rarely works. Ampicillin and trimethoprim-sulfamethoxazole are the most effective in killing gram-negative organisms and controlling this type of folliculitis. A drug called isotretinoin is especially effective for treating this condition. It is not an antibiotic, but a drug that is derived from the antioxidant beta-carotene. This medication can eradicate facial lesions in as little as two to three months. Since it is not an antibiotic, however, it has no effect on the gram-negative organisms on the skin.

Acne Management

Once the folliculitis subsides, treating any remaining acne is important. Since the use of antibiotics increases the risk for gram-negative folliculitis, topical creams and cryotherapy should be considered. Topical treatments that contain salicylic acid or benzoyl peroxide can reduce the amount of oil on the skin and prevent the pores from becoming clogged. Cryotherapy, also known as slush therapy or dry ice therapy, which involves the application of dry ice to skin affected by acne. This treatment can help reduce the number of acne lesions and may even help prevent scarring.

Exposed Skin Care

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Leigh Ann

About Leigh Ann

I am an experienced medical writer who has written several articles about acne. I also wrote an e-book about acne. I'm interested in the topic because it affects so many people, from teens to people in their 40s.

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