Writing with an update on my gram-negative beard folliculitis, which I’ve been battling since 2024. Presents as pustules (normally with a hair in the middle) in my beard with persistent redness on the cheeks and a faint itch that comes and goes. Think it started when a derm gave me clindamycin topical to use without BP to balance it out, which can cause overgrowth of gram-negative bacteria. Have run the gamut on solutions over the last 18 months:
- What didn’t work: BP, hibiclens, topical antibiotics, diet (cutting dairy, carbs, etc.)
- What somewhat worked: I’ve been on a course of 30mg/day accutane since May 2024 which may have had some impact, at least initially, but was never fully clear. The only real impact I’ve seen is on Bactrim 2x/day, which seems to minimize activity but not get rid of it completely
After exhausting the above, I’ve decided to bite the bullet and go through laser hair removal under the supervision of a dermatologist which I’ve read has worked as an option of last resort for other folks. It’s not cheap (~$480/session) but I wanted to have a medical professional oversee it with top-notch lasers (Alexandrite 755m). So far results are so-so and might even be aggravating it, though I believe getting rid of the hair will hopefully solve it long term.
Session 1 (June 9th, 2025)
- Shaved down fully with an electric razor the night beforehand. Skin was very red for 48-72 hours after the session, and I could see some darker hairs that had “popped out” of the follicle immediately
- Began shedding hair 7-14 days out from the session. Shed probably 75% of my fairly thick beard after session one, which is a pretty remarkable from what I read
- Got a deeper cystic spot (which I never get) two weeks post-session. It very quickly came to a head in 24 hours and then went down. Hypothesized that it has something to do with the laser
- Had a bit of activity where I still had hair, but felt more minimal. Note that while my beard is mostly brown/black, I have a good amount of blonder hairs mixed in that shed much less at the first session
- Note: I was on 1x/day Bactrim from my primary doc when I did my first session on 6/6, as we were seeing if a longer antibiotic course had any effect
Session 2 (July 7th, 2025)
- Finished the Bactrim course on the 7/5 right before and went into the session fairly clear. Skin seemed to “handle” the laser well and it hurt less as I had less hair on my face, we bumped up the joules
- Got another cystic spot (similar to the last one) three days following the laser. Fairly convinced it’s some sort of reaction of my messed up follicles to the laser, being activated or trying to come out from the laser
- Have been flaring during weeks 2-3 post session (now) – pustule spots on left and right cheeks, and a few pustules in my mustache area which I didn’t laser because I don’t really get activity there
My hypothesis is that since I think my folliculitis is more of an issue with my follicles and my immune system - rather than purely bacterial - I’ll still have activity where I still have hair. I plan to keep going with the laser to try and get at the blonder hairs that remain + see if I can get back on Bactrim until I’m further in my course
Questions: Has anyone else who did laser dealt with a flare up after the first few sessions? Was the laser able to get at blonder hairs after enough sessions?