It occurs when follicles in the skin become inflamed from a bacterial infection. It can sometimes develop in people who are trying to treat another form of severe acne with topical or oral antibiotics over a long period of time.

A Gram stain is used to detect certain bacteria; those that do not turn blue when introduced to the Gram stain are known as "Gram negative." Gram negative folliculitis can be difficult to treat, because the bacteria don't respond to many antibiotics used to treat severe acne. However, isotretinoin and certain antibiotics (often ampicillin and Proloprim, or trimethoprim) can successfully treat Gram negative folliculitis. Acne, also known as acne vulgaris, is a skin condition that affects millions of teenagers and adults alike. In fact, more than 80% of people worldwide have some form of acne between the ages of 11 and 30. While usually not serious, acne can cause negative psychological issues and, while not as common, long lasting scars. There are many different factors to why people get acne including an increase in hormone levels, excess oil (or sebum) in the skin, bacteria and more. Acne itself has many different varieties including whiteheads (closed comedo), blackheads (open comedo) and inflammatory papules. (Fortunately, there are many different products available on the market that can help prevent acne and treat it once someone already has it. Acne is classified clinically as being mild, moderate or severe. 

This grading scale is X OUT Acne somewhat subjective but how severe your acne is will determine the type of treatment you will be taking. Mild acne is usually self medicated with over the counter products which we will discuss. Mild acne that doesn't improve or worsens is typically treated with prescription products. In terms of medications, this article will discuss over the counter, prescription and supplemental products used to treat acne. Over The Counter(OTC) Salicylic Acid When To Use/Place In Therapy Mild acne in patients with sensitive skin. This medication is usually used by patients to self treat their acne and is typically one of the first medications people will try. How To Apply Apply 1 to 3 times per day, massage into skin and rinse off. Important Additional Information Not as effective as OTC benzoyl peroxide but is usually better tolerated, especially in those with sensitive skin. Benzoyl Peroxide When To Use/Place In Therapy Benzoyl peroxide is actually available as both an over the counter product and as a prescription. It ranges in strength from 2.5% to 10%. Along with salicylic acid, it is very commonly used to self treat acne. It is used for mild to moderate acne and is almost always used in combination with a prescription product to clear up more moderate to severe cases of acne. How To Apply Applied every other day to twice daily. Depending on the specific product you get, be it a gel, creamy wash, foam, be sure to read the package directions for application. Some products you apply and keep on while others you apply and wash off. Important Additional Information The most common side effect is redness of the skin, especially when you first start using the product. In fact, it's very common that your acne may appear worse because of the redness. 

This typically gets much better though as you continue to use the product. You should start once daily or even once every other day to become accustomed to the product to reduce the possibility of the redness. It is also recommended to start with either the 2.5% or the 5% benzoyl peroxide strength. Benzoyl peroxide is know to cause bleaching of towels and other fabrics so be aware of this! Benzoyl peroxide also can cause sun sensitivity. Prescription Products The "Retinoids" When To Use/Place In Therapy The retinoids are the most commonly used prescription products for acne, and there are a lot of them! They can either be used alone for mild acne or in combination with other products for more moderate to severe acne. Retinoid Products - Generic name followed by brand names in parenthesis Tretinoin (Retin-A, Retin-A Micro,? Tretin-X) Adapalene (Differin gel/cream) Tazarotene (Tazorac) All of these formulations come in a variety of different vehicles including creams, gels, and solutions. How To Apply Start with the lowest strength to avoid possible irritation. Typically it is recommended to start dosing at three times weekly, progressing to nightly use as tolerated. All retinoids are applied in the evening before going to bed. Ideally, you should wash the face with a non-medicated soap or gentle cleanser (such as Cetaphil), then apply a thin film of the cream, lotion, or gel to cover the entire face. Do not rinse off afterwards. Important Additional Information All of the retinoid products work in the same way, but certain products and formulations are either better tolerated or more effective. 

If what your doctor prescribed you isn't having the desired effect, it usually helps to change the retinoid product, strength or formulation. Tretinoin creams are the most commonly prescribed since they are available generically and are less expensive than other products. They do tend to cause the most irritation in the retinoid class however. There is a tretinoin product known as Retin-A micro which is the best tolerated of the retinoid bunch. Tretinoin is deactivated by sunlight and therefore should be applied at bedtime. Adapalene (Differin) products are considered to be slightly more efficacious than tretinoin products and certainly cause less skin irritation. Some formulations of adapalene are available generically just as tretinoin products are but in general does cost more. Sunlight deactivates adapalene just like tretinoin and therefore should be applied at bedtime. Tazarotene (Tazorac) is considered the most effective retinoid of all but is typically more irritating that the others. It commonly causes redness and scaling. Also, tazarotene is absolutely to be avoided in pregnancy or in those who wish to become pregnant. For all the retinoid products, as the strength increases so does the possibility of redness, flaking, and irritation. Ideally you want to start at a couple of times per week and move up to nightly dosing. In terms of picking a product formulation (cream vs gel etc.), the general recommendation is to pick a formulation based on your skin type. 

For people with more oily skin, it is recommended to go with a gel or solution because they contain more alcohol and tend to be a little bit more drying. In people with dry, flaky skin, cream is usually the best choice as it won't dry as much. Lastly, as will many different drug products, acne does tend to get worse when you start a medication before it gets better. It can sometimes take around a month to start seeing the positive effects of medication. Azelaic Acid When To Use/Place In Therapy Azelaic Acid (Azelex) is often used for patients with mild to moderate acne. It tends to be less irritating than other products so it is good for those with sensitive skin. How To Apply Azelaic Acid is usually gentle enough where is can be applied twice daily, in the morning and in the evening, at the start of therapy. Gently wash the face, pat dry and apply the product. Do not wash the face afterwards. Important Additional Information Azelaic Acid (Azelex) is usually considered slightly less effective than the retinoid products but again, it is great for people with sensitive skin. In those people with darker complexions, it has been know to cause hypopigmentation, also known as a loss in skin color. Dapsone (Aczone) When To Use/Place In Therapy Dapsone (Aczone) is a topical antibiotic formulation indicated for mild, moderate or even severe acne. It usually is used in combination with other products. Though Dapsone is classified as an antibiotic, it appears to work by preventing and treating the inflammatory process. It is usually very well tolerated and typically is regarded as a good option for patients that can't tolerate other medications well. 

How To Apply Dapsone should be applied to a clean and dry face. Dapsone does tend to be a little bit gritty so you can expect to feel that when you rub it in. Do not rinse your face afterwards. Important Additional Information Two things are important to know about Dapsone. First, it is usually fairly well tolerated and should not make acne worse before it gets better, unlike the retinoid products. Secondly, it usually is not used with benzoyl peroxide products as the combination of both can cause a temporary orange staining on the skin. Spironolactone (Aldactone) When To Use/Place In Therapy Spironolactone is an oral therapy and is usually reserved for more moderate to severe cases of acne where other treatments haven't worked. It is almost always used in combination with topical products and is almost exclusively used only in females with either excess androgenization (i.e. excess male hormones) or acne that comes and goes in cycles. Excessively oily skin, abnormally excessive hair growth and menstrual irregularities sometimes signal excess androgen in women. How To Apply The dosage for spironolactone is individualized in each patient with typical dosages ranging from 25 to 200 mg. Ideally you want the lowest effective dose. It should be taken in the morning because it is a mild diuretic (causes a loss of water through urination). Important Additional Information Spironolactone is know as an anti-androgen and is very effective in reducing sebum (oil). It works by blocking the conversion of testosterone to dihydrotestosterone.