Examining 15% Azelaic Acid Foam for the Treatment of Folliculitis: A Pilot Study.

BACKGROUND: Folliculitis is a frequently recurrent skin condition characterized by inflammatory papules and pustules on numerous body areas arising from follicular irritation induced by shaving or trauma but might also arise in the presence of bacterial or fungal organisms. Oral and topical antibiotics remain the mainstay of treatment, but the chronicity of the condition requires a safe maintenance therapy. OBJECTIVE: The objective of this study was to examine the off-label use of 15% azelaic acid foam in the treatment of folliculitis. DESIGN: Subjects received 15% azelaic acid foam for twice daily application to all areas of folliculitis for four weeks. PARTICIPANTS: Twenty-six male or female subjects with dermatologist diagnosed folliculitis participated in this research. MEASUREMENTS: Assessments consisted of the dermatologist investigator and subjects evaluating several parameters on a five-point scale (0=none, 1=minimal, 2=mild, 3=moderate, 4=severe) at baseline, Week 2, and Week 4. The dermatologist investigator evaluated lesional erythema, lesional inflammatory papule size, extent of inflammatory papules, lesional pus, lesional pustule size, extent of pustules, and overall folliculitis assessment. The subjects assessed itching associated with folliculitis, pain associated with folliculitis, lesional pus, lesional redness, extent of involvement, and overall folliculitis assessment. RESULTS: After four weeks of 15% azelaic acid foam treatment, the investigator noted a 67-percent reduction in lesional erythema, 73-percent reduction in lesional inflammatory papule size, 87-percent reduction in extent of pustules, and 78-percent reduction in overall folliculitis. The subjects reported a reduction of 60-percent in folliculitis itching, 67-percent reduction in pain, 73-percent reduction in lesional pus, 51-percent reduction in lesional redness, and 59-percent reduction in extent of folliculitis involvement. CONCLUSION: Azelaic acid 15% foam used off-label might be a useful treatment or adjunctive therapy for folliculitis.