Gram-negative rod superinfections of facial pustules are reported in a group of patients with acne vulgaris. These pustules contained no keratinous plugs and gram-negative rods were the dominant organism. The lesions were often concentrated around the nose and the infecting gram-negative rod was recoverable from both nostrils. The long-term use of antibacterial soap and various systemic antibiotics is discussed as the possible cause of this problem. Therapy for this condition has been difficult since appropriate antibiotics only suppress the infection. Prevention of radical changes in the normal bacterial flora may be the only solution.
Fulton JE, Leyden J, Marples R. Gram-Negative Folliculitis in Acne Vulgaris. Arch Dermatol. 1968;98(4):349-353. doi:10.1001/archderm.1968.01610160023005