Gram Negative Folliculitis - Causes, Symptoms and Treatment

Gram negative folliculitis is an acne-like disorder caused by a bacterial infection. Gram negative bacteria include Escherichia coli, Pseudomonas aeruginosa, Serratia marcescens, Klebsiella and Proteus species. Patients with acne vulgaris and rosacea and usually develops in patients who have received systemic antibiotics for prolonged periods. Gram-negative folliculitis should be considered in patients with acne who have a flare-up of pustular or cystic lesions and in patients whose acne is resistant to treatment. Gram-negative folliculitis may also occur in the setting of hot-tub immersion and in people infected with HIV. An inverse relationship has been demonstrated between the presence of gram-positive organisms and gram-negative organisms in the pharyngeal, axillary, and toe-web flora. In patients with acne who are treated with oral antibiotics, the number of Staphylococcus aureus organisms and diphtheroids decreases and the number of coagulase-negative staphylococcal and enterobacterial organisms increases in the nose. Usually, gram-negative bacteria constitute less than 1% of the total bacterial flora in the nose. In patients with gram-negative folliculitis, enterobacteria constitute approximately 4% of the total bacterial flora. Folliculitis caused by Pseudomonas organisms is typically associated with immersion in hot tubs and swimming pools, resulting in a generalized folliculitis. Acinetobacter baumannii folliculitis of the face, neck, arms, and upper part of the trunk has been reported in a patient with AIDS.

Gram negative folliculitis differs from acne in ways. Most of the lesions are pustules with relatively few papules and comedones. Gram-negative folliculitis has no associated increase in mortality. Morbidity is related to local pain and to the unwanted cosmetic effect of the folliculitis. Gram-negative folliculitis is a relatively uncommon complication of prolonged antibiotic therapy. In 2 studies, approximately 4% of patients with acne vulgaris who were under treatment with broad-spectrum antibiotics reported this infection. However, the frequency of this infection is probably generally underestimated because clinicians rarely perform correct sampling and bacteriology. Gram-negative folliculitis is largely a complication of acne vulgaris and thus is expected to follow the age distribution of that entity, a slightly increased age at onset has been observed. The tendency for this disease to begin after the early teenage years is most likely because most patients who develop gram-negative folliculitis have undergone treatment of acne with a broad-spectrum antibacterial agent for a prolonged period. Treatment of gram-negative folliculitis includes the use of isotretinoin and systemic antibiotics. Gram-negative folliculitis in acne and rosacea patients is best treated with isotretinoin (0.5-1 mg/kg daily for 4-5 months).

Causes of Gram Negative Folliculitis

Common Causes and Risk factors of Gram Negative Folliculitis

Bacterial infection (Pseudomonas organisms ).
Citrobacter.
Klebsiella.
Escherichia.
Serratia.
Proteus.
Acinetobacter baumannii.

Sign and Symptoms of Gram Negative Folliculitis

Common Sign and Symptoms of Gram Negative Folliculitis

Pain.
Pus-filled pimples.

Treatment for Gram Negative Folliculitis

Common Treatment for Gram Negative Folliculitis

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 treat with isotretinoin (13-cis-retinoic acid). Patients were treated for 14–36 weeks with a daily dose of 0.5–1.5 mg isotretinoin/kg body weight.
Gram-negative folliculitis caused by Pseudomonas organisms in whirlpools usually subsides spontaneously within 10 days without recurrence. baumannii folliculitis in the setting of AIDS has responded to intravenous treatment with ticarcillin-clavulanic acid.
Most patients have ordinary acne in addition to gram-negative folliculitis. Once the folliculitis has responded, residual acne must be treated by other methods, including retinoic acid, benzoyl peroxide, cryotherapy, and other therapies

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