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