Emerging treatments
Alternative antibiotics
For deep folliculitis caused by MRSA, vancomycin and linezolid are widely available for use in clinical practice; however, newer antibiotics have also been recommended for use in patients with vancomycin sensitivity or vancomycin-resistant Staphylococcus aureus. Tigecycline and daptomycin are available for clinical use in MRSA-complicated skin and soft tissue infections (cSSTI). Tigecycline, a derivative of minocycline, inhibits 30S ribosomal protein synthesis and is approved for MRSA cSSTI. Nausea and vomiting are predominant side effects, but pancreatitis and elevated liver enzymes have also been reported.[49] Daptomycin, a depolarising agent of bacterial cell membranes, is also approved for MRSA cSSTI. Antibiotic resistance to daptomycin has already been reported, as well as myopathy and eosinophilic pneumonia as side effects.[49] The US Food and Drug Administration (FDA) has approved four newer antibiotics for adults with acute bacterial skin and skin structure infections (ABSSSI; defined as >75 cm² erythema, oedema, or induration) with MRSA: dalbavancin, tedizolid, oritavancin, and delafloxacin. The longer duration of action of dalbavancin and oritavancin permit less frequent intravenous dosing and possible earlier hospital discharge. Tedizolid and delafloxacin are both available in intravenous and oral formulations.[50] Current labelling recommends using these four newer antibiotics in culture-positive ABSSSIs to prevent the spread of antibiotic-resistant bacteria. Omadacycline is a modernised tetracycline with broad-spectrum activity that is designed to overcome tetracycline resistance. It is approved by the FDA for ABSSSI caused by Staphylococcus aureus (methicillin-susceptible and methicillin-resistant isolates), Streptococcus pyogenes, Enterococcus faecalis, Enterobacter cloacae, and Klebsiella pneumoniae. In three global phase 3 studies involving about 2000 adults, omadacycline met all primary and secondary efficacy outcomes.[51][52]
Interventions for folliculitis decalvans
At the current time, definitive treatment for folliculitis decalvans is lacking. In a review, the most common treatment was a combination of clindamycin and rifampicin. Developing treatments include: red light photodynamic therapy, laser, tacrolimus, and tretinoin.[14][53]
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