Gram negative folliculitis

Gram-negative folliculitis is a severe form of acne that usually results from extended usage of certain antibiotics to treat acne. It can be treated with isotretinoin, also known as Accutane.

One severe form of acne is known as gram-negative folliculitis. It is an advanced form of inflammatory acne. When inflammatory acne persists beyond treatment and even worsens, gram-negative folliculitis sets in. After continued resistance to antibacterial treatment, the body gradually develops immunity to the antibiotic, eventually producing acne that is worse than ever before. Four percent of people who have inflammatory acne will go on to develop gram-negative folliculitis.

Why is it Called “Gram-Negative” Folliculitis?

  • Gram-negative folliculitis is caused by an antibiotic-resistant bacterial infection, usually after a lengthy, unsuccessful course of intensive antibiotic treatment (usually a topical antibiotic or tetracycline oral antibiotic) for moderate to severe inflammatory acne vulgaris.
  • When lab technicians test for bacterial infections, they run the sample through a process called gram staining. Most bacteria will stain blue in the gram test; the bacterial flora normally found on your face is gram-positive, but the particular bacteria that is the culprit for gram-negative folliculitis does not.
  • Basically, if you take or use certain antibiotics for too long, this causes what is called bacterial interference. The gram-positive bacterial flora is replaced by gram-negative bacteria that proliferates in your nasal cavities and mucous membranes.
  • Klebsiella, Escherichia coli, Pseudomonas, Serratia Marcescens, Enterobacter, and Proteus bacteria are the usual causes of gram-negative folliculitis.
  • “Folliculitis” describes the fact that this bacteria inflames the hair follicle.

Who Gets Gram-Negative Folliculitis?

This people are more susceptible to develop gram-negative folliculitis:

  • Those who have undergone extensive, yet unsuccessful, antibiotic treatment for severe cases of inflammatory acne.
  • People with severe seborrhea (overactive oil glands in the face, which produces very oily skin).
  • Individuals with HIV/AIDS
  • People with acne rosacea
  • If you have recently bathed in a Jacuzzi or hot tub that is contaminated with the Pseudomonas bacteria.
  • People who get an ear infection (external otitis) from Pseudomonas bacteria.

symptoms and Appearance of Gram-Negative Folliculitis

  • The main symptom of gram-negative folliculitis is a sudden increase in the number and severity of acne lesions despite antibacterial treatment. Sufferers who previously had whiteheads and blackheads will frequently develop numerous cysts, pustules and nodules, especially on the face.
  • Gram-negative folliculitis mainly occurs on the face, especially clustered around the nose, on the cheeks, and chin.
  • Sufferers will develop large clusters of nodules and cystic lesions that burrow and interconnect.
  • The skin appears red, inflamed, and irregular, and the affected area is painful.
  • People with gram-negative folliculitis often have acne vulgaris, too, so they will often have whiteheads, blackheads, and papules in other parts of their faces.

Treatment of Gram-Negative Folliculitis

Since it results from antibiotic-resistant bacteria, treating gram-negative folliculitis used to be very difficult. Sufferers can be prescribed systemic, bacteriostatic antibiotics such as ampicillin, although there is conflicting evidence about the effectiveness of antibiotics on gram-negative folliculitis.

The preferred treatment of gram-negative folliculitis is isotretinoin (Accutane). Isotretinoin is a beta-carotene derivative of vitamin A, and it has proven effective at treating many kinds of acne, including gram-negative folliculitis. Isotretinoin, prescribed as Accutane, helps reduce sebum production, which reduces the pore blockage. It also dries out the mucous membranes, which are the normal places where the gram-negative bacteria reside, thus decreasing the bacterial habitat’s ability to flourish.

Isotretinoin (Accutane) should be taken for a period of three to six months to help eradicate gram-negative folliculitis. Most gram-negative folliculitis sufferers see major improvements in their condition within three months, even without antibiotic treatment.

This uncommon skin ailment can cause significant physical and emotional pain, but gram-negative folliculitis doesn’t have to be permanent. With the proper treatment, your days of gram-negative folliculitis can be left behind.

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