Treatment of Gram-Negative Folliculitis in Patients with Acne

American Journal of Clinical Dermatology volume 4, pages273–276(2003)Cite this article

Abstract

Gram-negative folliculitis may be the result of long-term antibacterial treatment in acne patients. It is caused by bacterial interference and replacement of the Gram-positive flora of the facial skin and the mucous membranes of the nose and infestation with Gram-negative bacteria. These Gram-negative bacteria include Escherischia coli, Pseudomonas aeruginosa, Serratia marescens, Klebsiella and Proteus mirabilis. The occurrence of Gram-negative folliculitis should be considered in acne patients in whom oral treatment with tetracyclines has not resulted in a significant improvement of acne lesions after 3–6 months’ treatment. The occurrence of Gram-negative folliculitis in acne patients is believed to be generally underestimated, since correct sampling and bacteriology is rarely performed by clinicians. Gram-negative folliculitis in acne and rosacea patients is best treated with isotretinoin (0.5–1 mg/kg daily for 4–5 months).

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References

  1. 1.

    Fulton JE, McGinley K, Leyden JJ, et al. Gram-negative folliculitis in acne vulgaris. Arch Dermatol 1968; 98: 349–353

    PubMed  Article  Google Scholar 

  2. 2.

    Neubert U, Jansen T, Plewig G. Bacteriologic and immunologic aspects of Gram-negative folliculitis: a study of 46 patients. Int J Dermatol 1999; 38: 270–274

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Leyden JJ, Marples RR, Mills Jr OH, et al. Gram-negative folliculitis: a complication of antibiotic therapy in acne vulgaris. Br J Dermatol 1973; 88: 533–538

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Plewig G, Braun-Falco O. Gramnegative Folliculitis. Hautarzt 1974; 25: 541–546

    PubMed  CAS  Google Scholar 

  5. 5.

    Forsgren A, Banck G. Influence of antibiotics on lymphcyte function in vitro. Infection 1978; 6: 91–97

    Article  CAS  Google Scholar 

  6. 6.

    Esterly NB, Koransky JS, Furey NL. Neutrophil chemotaxis in patients with acne receiving oral tetracycline therapy. Arch Dermatol 1984; 120: 1308–1313

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Marples RR, Fulton Jr JE, Leyden J. Effects of antibiotics on the nasal flora in acne patients. Arch Dermatol 1969; 99: 647–651

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Boni R, Rosacea. Acne and other diseases of the seborrheic spectrum. Schweiz Rundsch Med Prax 2000; 89: 566–570

    CAS  Google Scholar 

  9. 9.

    Boni R, Hafner J, Krasovec M. Acne and its treatment possibilities. Schweiz Med Wochenschr 1999; 129: 1496–1503

    PubMed  CAS  Google Scholar 

  10. 10.

    Chastain MA. A cycle: recurrent gram-negative folliculitis with Citrobacter diversus (koseri) following eradication of recurrent stapylococcal pyoderma [letter]. Arch Dermatol 2000; 136: 803

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Bartholow P, Maibach HI. Gram-negative folliculitis without systemic antibiotics [letter]. Arch Dermatol 1979; ll5: 676

    Article  Google Scholar 

  12. 12.

    Bottone EJ, Perez AA, Oeser JL. Loofah sponges as reservoirs and vehicles in the transmission of potentially pathogenic bacterial species in human skin. J Clin Microbiol 1994; 32: 469–472

    PubMed  CAS  Google Scholar 

  13. 13.

    Hobbs JR. IgM deficiency. In: Bergsma D, Good RA, Finstad J, editors. Imrrrunodeficiency in man and animals. Sunderland: Sinauer Press, 1975, 116

  14. 14.

    Suter S, Berger D, Despont JP. Low levels offunctional a-1-proteinase inhibitorin the promotion of C3-cleavage by granulocyte-neutral proteases in pleural empyema. J Infect Dis 1984; 149: 935–941

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Blankenship ML. Gram-negative folliculitis: follow-up observation in 20 patients. Arch Dermatol 1984; 120: 1301–1303

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Landthaler M, Kummermehr J, Wagner A, et al. Inhibitory effects of 13-cis-retinoid acid on human sebaceous glands. Arch Dermatol Res 1980; 269: 297–309

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Ortonne JP. Oral isotretinoin treatment policy: do we all agree? Dermatology 1997; 195: 134–137; discussion 38-40

    Article  Google Scholar 

  18. 18.

    James WD, Leyden JJ. Gram-negative folliculitis: recognition and treatment. J Am Acad Dermatol 1983; 9: 165–166

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    James WD, Leyden JJ. Treatment of Gram-negative folliculitis with isotretinoin: positive clinical and microbiologic response. J Am Acad Dermatol 1985; 12: 319–324

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Jones DH, Cunliffe WJ, King K. Treatment of Gram-negative folliculitis with 13-cis-retinoid acid. Br J Dermatol 1983; 108: 252–253

    Google Scholar 

  21. 21.

    Neubert U. Plewig G, Ruhfus A. Treatment of Gram-negative folliculitis with isotretinoin. Arch Dermatol Res 1986; 278: 307–313

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Plewig G, Nikolowski J, Wolff HH. Action of isotretinoin in acne, rosacea and gram-negative folliculitis. J Am Acad Dermatol 1982; 6: 766–785

    PubMed  Article  CAS  Google Scholar 

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Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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  1. Department of Dermatology, University Hospital, Gloriastreel 31, 8091, Zürich, Switzerland

    Dr Roland Böni & Brita Nehrhoff

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  1. Dr Roland Böni
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  2. Brita Nehrhoff
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Correspondence to Dr Roland Böni.

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Böni, R., Nehrhoff, B. Treatment of Gram-Negative Folliculitis in Patients with Acne. Am J Clin Dermatol 4, 273–276 (2003). https://doi.org/10.2165/00128071-200304040-00005

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Keywords

  • Acne
  • Isotretinoin
  • Rosacea
  • Antibacterial Treatment
  • Pyoderma