What causes gram-negative folliculitis?

Updated: Aug 07, 2019
  • Author: Mordechai M Tarlow, MD; Chief Editor: William D James, MD  more...
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Answer

Systemic antibiotics, such as tetracyclines, can alter the nasal flora. The resultant overgrowth of gram-negative bacteria can lead to folliculitis.

Type 1 lesions are usually associated with a lactose-fermenting, gram-negative rod, including Klebsiella, Escherichia, and Serratia species. Cases associated with Citrobacter and Morganella species, other organisms of the Enterobacteriaceae family, have also been described. [3, 4, 5]

Type 2 lesions are associated with Proteus species. These species are motile and, thus, have the ability to invade more deeply, producing the large suppurative abscesses that result in deeper cystic lesions.

Folliculitis caused by Pseudomonas organisms is typically associated with immersion in hot tubs and swimming pools, resulting in a generalized folliculitis. [6] Aeromonas hydrophila has also been associated with water sources, including an inflatable pool. [7, 8] Home spas have also been implicated in causing gram-negative folliculitis. In the reported patients who were swimmers, a sudden unmanageable flare-up of facial acne associated with chronic bilateral otitis externa was reported. A case of Acinetobacter baumannii folliculitis of the face, neck, arms, and upper part of the trunk has been reported in a patient with AIDS. [9]


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