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Introduction
Gram-negative folliculitis (GNF) is a hair follicle infection by Gram-negative organisms that can occur as a complication in patients receiving prolonged treatment with broad spectrum antibiotics for the treatment of acne vulgaris and rosacea. It must be suspected in a sudden exacerbation of acne treatment or in patients non-responding to conventional acne treatments [1]. There are two clinical variants of GNF; type I, is the most common, about 80% of cases, with the presence of multiple papules and pustules in the middle of the face; the type II occurs in 20% of cases and is characterized by inflammatory nodules or cysts [1-4]. Oral isotretinoin is the treatment of choice at doses of 0.5 to 1mg/kg/day for 4-5 months [4]. Its mechanism of action is to control the proliferation of Gram-negative bacteria through microenvironmental changes produced in the skin and nasal mucous [5,6].
Case Report
A 24-year old female came to our service with a skin disease that affects the perioral zone, characterized by multiple papules and pustules (Fig. 1 [See PDF]A). Patient started one week before their assessment and with a history of having received tetracycline hydrochloride for 2 months for mild to moderate acne, as well as topical clindamycin intermittently for six months. The patient underwent clinical examination and laboratory test such as Gram stain (Fig. 1 [See PDF]C) and culturing on McConkey agar (Fig. 1 [See PDF]D). A treatment with oral isotretinoin was proposed with resolution of the skin disease within a 3 month treatment period (Fig. 1 [See PDF]B).
| Figure 1 [See PDF]. A. Perioral pustules. B. Post-treatment control. C. Gram-negative bacilli (x100). D. Lactose +, red-pink colonies (McConkey agar). Escherichia Coli |
Discussion
Gram-negative folliculitis was first reported in 1968 by Fulton et al [1], in a group of patients with acne vulgaris resistant to conventional treatments [1-4]. It is a hair follicle infection that occurs mainly in patients with inflammatory acne or rosacea that have long treatments with broad spectrum antibiotics, mainly tetracycline [3- 5]. It should be suspected when there is an increase in pustules with resistance to systemic treatment [4,6]. It is reported a prevalence of 4%. Prolonged treatment alters the normal bacterial flora of the nasal mucous and adjacent skin with reduced Gram-positive bacteria and coagulase positive...