Treatment can be difficult and is aimed at controlling rather than “curing” the condition. Topical antibiotics such as 1% clindamycin can be tried in the first instance in mild cases. However, more severe disease will require oral antibiotics such as doxycycline, minocycline, erythromycin or dicloxacillin. Rifampicin is an antibiotic that is said to have stronger action against S. aureus and is usually prescribed together with another antibiotic (clindamycin) to prevent emergence of bacteria resistance.
Some affected individuals will require long-term treatment to prevent relapse. S. aureus, if present, will need to be eradicated by using intranasal antibiotics such as 2% mupiricin ointment. In addition, an antiseptic or tar shampoo may be recommended.
The addition of topical and intralesional (injections) corticosteroids helps reduce inflammation and symptoms of itching and burning. Oral corticosteroids are occasionally prescribed to control aggressive disease.
Many other treatments such as oral isotretinoin, dapsone and zinc sulphate have been used with variable success. Laser treatment or surgical procedures are not commonly used and flare-ups of the condition can occur following treatment.