Gram-Negative Folliculitis

  • Ani L. TajirianEmail author
  • Leon H. Kircik


Gram-negative folliculitis is a complication of treatment of acne or rosaceas with long-term oral antibiotics, usually tetracyclines. It is caused by the replacement of the gram-positive flora of the mucous membranes of the nose with gram-negative bacteria, which is spread to the face. Common causative organisms include Escherichia coli, Pseudomonas aeruginosa, Serratia marcescens, Klebsiella, and Proteus mirabilis. Gram-negative folliculitis should be considered in acne patients who have a flare-up of pustular or cystic lesions while on antibiotics and in patients who have no significant improvement of acne lesions after 3–6 months of antibiotic therapy.


Methylene Blue Serratia Marcescens Proteus Mirabilis Acne Lesion Acne Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Fulton Jr JE, McGinley K, Leyden J, Marples R. Gram-negative folliculitis in acne vulgaris. Arch Dermatol. 1968;98:349–53.PubMedCrossRefGoogle 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;38:270–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Esterly NB, Koransky JS, Furey NL, Trevisan M. Neutrophil chemotaxis in patients with acne receiving oral tetracycline therapy. Arch Dermatol. 1984;120:1308–13.PubMedCrossRefGoogle Scholar
  4. 4.
    Bottone EJ, Perez 2nd AA, Oeser JL. Loofah sponges as reservoirs and vehicles in the transmission of potentially pathogenic bacterial species to human skin. J Clin Microbiol. 1994;32:469–72.PubMedGoogle Scholar
  5. 5.
    Leyden JJ, Marples RR, Mills Jr OH, Kligman AM. Gram-negative folliculitis—a complication of antibiotic therapy in acne vulgaris. Br J Dermatol. 1973;88:533–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Chastain MA. A cycle: recurrent gram-negative folliculitis with Citrobacter diversus (koseri) following eradication of recurrent staphylococcal pyoderma. Arch Dermatol. 2000;136:803.PubMedCrossRefGoogle Scholar
  7. 7.
    Mostafa WZ. Citrobacter freundii in gram-negative folliculitis. J Am Acad Dermatol. 1989; 20:504–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Bartholow P, Maibach HI. Gram-negative folliculitis without systemic antibiotics? Arch Dermatol. 1979;115:676.PubMedCrossRefGoogle Scholar
  9. 9.
    Boni R, Nehrhoff B. Treatment of gram-negative folliculitis in patients with acne. Am J Clin Dermatol. 2003;4:273–6.PubMedCrossRefGoogle Scholar
  10. 10.
    James WD, Leyden JJ. Treatment of gram-negative folliculitis with isotretinoin: positive clinical and microbiologic response. J Am Acad Dermatol. 1985;12:319–24.PubMedCrossRefGoogle Scholar
  11. 11.
    Plewig G, Nikolowski J, Wolff HH. Action of isotretinoin in acne rosacea and gram-negative folliculitis. J Am Acad Dermatol. 1982;6:766–85.PubMedCrossRefGoogle Scholar
  12. 12.
    Landthaler M, Kummermehr J, Wagner A, Plewig G. Inhibitory effects of 13-cis-retinoic acid on human sebaceous glands. Arch Dermatol Res. 1980;269:297–309.PubMedCrossRefGoogle Scholar
  13. 13.
    Neubert U, Plewig G, Ruhfus A. Treatment of gram-negative folliculitis with isotretinoin. Arch Dermatol Res. 1986;278:307–13.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Fletcher Allen Health CareUniversity of Vermont College of MedicineBurlingtonUSA
  2. 2.Webster Management Inc.OaklandUSA
  3. 3.Department of DermatologyMt. Sinai School of MedicineNew YorkUSA
  4. 4.Indiana University School of MedicineIndianapolisUSA

Personalised recommendations