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June 1979

Gram-Negative Folliculitis Without Systemic Antibiotics?

Author Affiliations

Santa Rosa, Calif

San Francisco

Arch Dermatol. 1979;115(6):676. doi:10.1001/archderm.1979.04010060002007

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To the Editor.—  It has been assumed that acne-related Gram-negative folliculitis is secondary to systemic antibiotic acne therapy. We have observed several patients with Gram-negative folliculitis in whom we cannot obtain a history of systemic antibiotic therapy.A 16-year-old boy was first seen on Aug 31, 1977, with cystic acne of the face and back. Therapy was instituted with cleansers, 2% clindamycin lotion, and ultraviolet light. Benzoyl peroxide gel (5%) was subsequently added. In January 1978, clindamycin therapy was discontinued and 2% erythromycin lotion substituted. Only moderate improvement was noted. For these reasons, cultures were performed, revealing Escherichia coli from pus from his face; subsequently repeated several times, cultures continued to show heavy growth of E coli from pus and anterior nares.Does this represent Gram-negative folliculitis secondary to one of the three topical antimicrobials (clindamycin, erythromycin, and benzoyl peroxide), or occult systemic antibiotic exposure? Or can this process occur

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