Gram-Negative Folliculitis

If your acne isn’t improving—or seems to be getting worse—with standard treatments, you may be dealing with a less common condition called gram-negative folliculitis. At SOMA Skin & Laser, our dermatologists specialize in diagnosing and treating complex and treatment-resistant skin conditions like this one.

What Is Gram-Negative Folliculitis?

Gram-negative folliculitis is a bacterial infection of the hair follicles caused by gram-negative organisms, a class of bacteria that are resistant to many common antibiotics. It most often occurs in people who have been on long-term antibiotic therapy for acne, which can disrupt the balance of skin flora and allow resistant bacteria to thrive.

Who Is at Risk?

Gram-negative folliculitis is rare, but more likely in individuals who:

  • Have been on oral antibiotics (like tetracycline or doxycycline) for prolonged periods

  • Have persistent or worsening acne

  • Experience pustules and nodules around the nose, chin, and cheeks

  • Have flaring acne after initial improvement

Signs and Symptoms

  • Sudden acne flare-up after antibiotic treatment

  • Deep, red pustules and nodules, often painful

  • Typically affects the central face: nose, chin, jawline

  • May resemble cystic acne but doesn’t respond to usual therapies

Diagnosing Gram-Negative Folliculitis

Accurate diagnosis requires expertise. At SOMA Skin & Laser, we:

  • Perform a thorough skin exam

  • Take a bacterial culture from pustules or lesions

  • Rule out other causes of treatment-resistant acne

Treatment Options

Once confirmed, gram-negative folliculitis can be effectively treated with the right antibiotics and skincare regimen. Options may include:

1. Oral Treatments Effective Against Gram-Negative Bacteria

  • Isotretinoin (Accutane) in severe or resistant cases

  • Trimethoprim-sulfamethoxazole (Bactrim)

  • Ampicillin or amoxicillin-clavulanate in certain cases

  • Ciprofloxacin or other quinolones (used with caution)

2. Discontinuation of Long-Term Antibiotics

Reducing or stopping previous acne medications may be necessary to allow the skin’s natural microbiome to recover.

3. Supportive Skincare

  • Antibacterial cleansers

  • Avoidance of topical steroids or comedogenic products

  • Gentle skin barrier repair routines

Why Choose SOMA Skin & Laser?

  • Board-Certified Dermatologists with expertise in resistant and atypical acne

  • On-site bacterial culture and accurate diagnosis

  • Advanced treatment options, including isotretinoin when appropriate

  • Comprehensive care that addresses both skin health and cosmetic concerns

Don’t Let Persistent Acne Go Untreated

If your acne isn’t responding to treatment or seems to worsen with antibiotics, gram-negative folliculitis may be the cause. Let our experienced team at SOMA Skin & Laser help you find answers and relief.

Call Us Today: 973-763-7546

**Results may vary patient to patient. There is no guarantee that any specific result can be achieved.
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