Gram -- negative folliculitis -- a complication of antibiotic therapy in acne vulgaris.

Fifty cases of Gram-negative folliculitis have been identified amongst 1200 new cases of acne vulgaris in a period of 4 years. Two clinical varieties are recognized. Type I, the more common, presents as superficial pustules, usually grouped around the nose and is associated with a lactose fermenting Gram-negative rod. Type II lesions are characterized by deep nodular and cystic lesions; Proteus appears to be the causative agent. The treatment of this condition is discussed. There has recently been a world-wide increase in systemic infections caused by Gram-negative organisms (Findland, Jones & Barnes, 1959; Barber, 1961; Johnstone, 1970; Adier, Martin & Findland, 1971). The widespread use of antibiotics effective predominantly against Gram-positive organisms has been incriminated as the probable cause for this shift. We previously reported a cutaneous example of antibiotic induced superinfection; namely. Gram-negative folliculitis complicating the treatment of acne vulgaris (Fulton et al., 1968). This syndrome consisted of the following: (1) an older aged acne patient who had been on antibiotics, usually tetracyclines, for prolonged periods, (2) pustular lesions grouped about the nose and fanning out on to the cheeks, (3) the recovery of Gram-negative lactose fermenting rods from the anterior nares and from one or more of the pustules, (4) histological evidence of an intrafollicular abscess without comedone formation and (5) clinical improvement following antibiotic therapy directed against the Gram-negative organisms. Our experience since has broadened to fifty patients. It is our intent in this report to delineate this syndrome from the viewpoint of diagnosis, pathogenesis and treatment. [ABSTRACT FROM AUTHOR]