Herpes and Folliculitis: Their Co-existence

The inflammation of hair follicles termed follicultis can effect an individual of any age, region or sex. It also can be initiated by one or more micro-organisms at a given instance. It is the damaged hair follicle, which is a pre-requisite to initiate folliculitis. It can then be invaded by staphylococcus aureus, the commonest infecting agent, fungus such candida, pityrosporum or malassezia , demodex mite, or virus of herpez class.

Herpes virus itself causes skin eruption. Its two different entities are seen in young children and adult age groups. Varicella (chickenpox) is one type which appears as systemic illness with typical skin eruption on face, trunk and other body parts. The rash  is quite distinct from typical folliculitis. It is vesiculo-papulo-pustular and a black scabbing at the end of this eruptive illness. All  forms of rash can be seen at one time on different parts of body. Face and trunk are mostly crowded with typical chickenpox rash as its commonly known name. This variety of herpes vericella skin eruption is most commonly confined to kids and young adults. The rash and the accompanying systemic illness is highly contagious in herpes vericella infection, either as droplets infection through coughing, sneezing or even the vesicular lesion can spread the illness.

The red pimple of folliculitis is papulo-pustular in appearance and it is seen in hairy parts of body, where injury to follicles gives way to invasion by micro-organism residing on skin as normal flora. Folliculitis can spread from one individual to another due to unhygienic lifestyle. Sharing the same toiletries, swimming pools, hot bath tubs are the common mode of its spread.

As for management is concerned, vericella (chicken pox) is self limiting, and rash resolve in about week to ten days time. Only supportive treatment is enough. Itching is controlled by some soothing agent, such as calamine lotion. A local anti-viral cream (zovirex) is also used when extensive facial eruption occur.

Treatment protocol for simple folliculitis stresses more on adopting better hygiene in daily life. Anti-septic soap baths and concurrent use of some solution of anti-infective property must be used along with warm damp washout of effected skin will help in faster healing. Itching is controlled with anti-allergic formulations.

Folliculitis and herpes varicella share common symptoms of severe itching and therefore spread from one part to another part of body. Same virus reactivates many years of being dormant after primary infection but it is localized to nerves and the rash is also distributed in same pattern of nerves. This is commonly called herpes zoster or shingles. Severe pain is predominant in shingles.

In some instances, herpes simplex virus itself causes inflammation of follicles commonly at bearded area. This  can become stubborn in responding to conventional methods of treatment unless a definitive diagnosis is made by isolating virus by doing smear of skin lesion and positive culture for infecting virus. Anti-viral drugs can effectively treat folliculitis of HSV, given for 5-10 days. Isolation of infected individual until active phase is over can save many  from getting troublesome skin condition

Types of Folliculitis & Their Remedy

Human skin is in most part covered with hair, whether small and silky or long and relatively tough. In all kinds they grow from small follicles, which has roots or attachments to deeper skin tissue. This gives some hint of what may occur if any damage takes place to follicles, opening an entry point for number of micro-organism harboring on normal skin or from  unhealthy environment. When a person gets folliculitis it can take the following shape or severity:

1) Superficial folliculitis,  80%  cases of folliculitis ,in which damage and subsequent infection remains limited to upper layer of skin,  as superficial pustular lesions. This may just appear as raised red area over skin in region of hair, a bump usually it is called. It has no specific location, as any area having hair follicle can become infected, like facial region specially shaving area including chin, scalp, buttocks, thighs, axilla, and trunk.

Treatment is based  on simple conservative approach, with more emphasis on taking shower regularly with some potent anti-bacterial soap, or regular application of benzyl peroxide, a potent local broad spectrum anti-bacterial preparation which effectively fasten healing process to full recovery without residual scaring or hair loss.

Occasionally, the simple form heals with simple measure but may leave a hardened nodular bump without any sign of redness or pain, seen at shaving area and also over the chest more commonly in dark skinned individuals.

As simple folliculitis or milder form is more itchy and tender,  using diphehydramine or some other anti-allergic and  pain killer is advisable. Applying moist hot compresses also help in clearing dead tissues as well as reduce itching.

2) Deep folliculitis, may morphologically be specific, occurring on its own causes or as complication of superficial folliculitis. The hallmark of deeper folliculitis is that infecting organism  penetrates deeper layers of  skin through damaged hair follicle, which in all probability may effect other parts of body once spread is not adequately treated. As it can be caused by different  classes of microbes, it can be discussed  individually. Even in all these different settings the basic principle of personal hygiene will apply, and use of conservative remedies used in superficial or simple folliculitis.

a) Bacterial folliculitis Most common micro-bacterium is staphylococcus , and anti-biotics of choice for treating folliculitis  by this organism are ciphalexin, dicloxicillin, or flocloxacillin in dose range of 250-500mg four times daily for ten days. Hot tub folliculitis is common incidence in person using public hot tub baths and swimming pools. The organism involved in such settings is usually pseudomonas aeruginosa  usually can be controlled with benzyl peroxide wash twice daily may suffice. But when it gets widespread as it commonly happens, suitable anti-biotic cover for 7-10 days is needed. Ciprofloxacillin is best choice, and dose  is 500mg two times /day.

b) Fungal folliculitis, most commonly on scalp, needs to be treated by topical ketoconazole shampoo 3-5 times per week/ econazole applied locally twice daily untill  condition heals up completely. If specific fungus is identified as in more severe infection oral anti-fungal drugs, such as fluconazole or itraconazole is given in dose range of 100mg -200mg once or twic daily for minimum of two weeks. As in most instances bacterial infection concurrently exist oral anti-biotics is also advisable as adjuvant treatment.

c) Viral folliculitis such as caused by herpes , has acyclovir available as treatment of choice in 200mg dose four times per day for 5-10 days duration.

d)Abscess can be one form of complicated   folliculitis, when  large collection of pus not only causes swelling of small bump but spreads into surrounding and deeper tissue. Most commonly  it is seen in facial and armpit region where not only the folliculitis becomes enlarged into swelling filled with increased amount of pus, even the lymph node draining the particular area becomes tender and enlarged too. The definitive approach to treatment is incision and drainage of pus filled cavity, until it is devoid of infected substance, sometimes surgeon may leave a sterile gauze to prevent refilling of space till healing is complete.  Use of anti-biotic may or may not be needed.

What ever type, severity , location folliculitis presents with, the corner stone of treatment is meticulous personal hygiene ,of which there is no alternative.