For many people, acne represents a transient cosmetic problem involving a few pimples they can treat with over-the-counter medications. But in some people, bad acne turns severe when they develop gram-negative folliculitis, or follicular acne, a form of acne that develops when infection inflames your hair follicles. Treatment of gram-negative folliculitis generally involves potent oral acne medications, according to the American Academy of Dermatology, or AAD.
Cause
Follicular acne generally starts out as common acne, which is caused by blockages in your hair follicles, according to the AAD. If your acne gets bad enough, your dermatologist likely will put you on oral antibiotics to treat the bacterial infection that makes acne worse. However, many strains of acne-causing bacteria have become resistant to commonly used antibiotics, and if you've taken oral antibiotics long term, you risk attracting a strain of bacteria that's resistant to almost all oral antibiotics. These types of bacteria, called "gram-negative" bacteria because of their reaction to a type of laboratory testing, can cause severe inflammation.
Appearance
Gram-negative folliculitis occurs only rarely in patients who have taken oral antibiotics for their acne. If you have gram-negative folliculitis, a rash with many pus-filled lesions will cover parts of your face and other acne-prone areas, according to DermNet. You'll have relatively few smaller pimples, whiteheads and blackheads. You'll likely suffer from severe inflammation, and your lesions can become painful to the touch.
Treatment
If you've developed gram-negative folliculitis, the odds are good that you're already under a dermatologist's care, since you've almost certainly been taking oral antibiotics for your acne. That's good news, because you'll need your dermatologist's help to treat this severe skin condition. In most cases, your dermatologist will prescribe the oral medication isotretinoin, or Accutane, for your follicular acne. Isotretinoin works against all four causes of acne, including blocked pores, excess oil, infection and inflammation. In some cases, your dermatologist might recommend a different type of antibiotic, such as trimethoprim or ampicillin.
Research
Researchers reporting in 2003 in the "American Journal of Clinical Dermatology" urged physicians to consider the possibility of gram-negative folliculitis in patients who fail to respond to tetracycline antibiotics within six months. That study, led by Dr. R. Boni, backed the use of isotretinoin in patients with gram-negative folliculitis. In another study, reported in the "Archives of Dermatology Research" in 1986, lead researcher Dr. U. Neubert treated 13 gram-negative folliculitis patients with isotretinoin for up to 36 weeks. In nine patients, the gram-negative bacteria disappeared completely, and four patients had minor recurrences.
Considerations
Isotretinoin, a form of vitamin A, most likely can knock out your gram-negative folliculitis, but the drug carries some major risks. According to Drugs.com, isotretinoin can cause severe damage to unborn children, so women never should take it when pregnant or when they're at risk of becoming pregnant. In addition, although researchers haven't proven a clear link, the drug may cause depression with thoughts of suicide. If this happens to you, stop using isotretinoin and contact your physician immediately.
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