From the Guidelines
Herpetic folliculitis should be treated with oral antiviral medications, such as valacyclovir (1 gram twice daily for 7-10 days), as it is the most effective treatment option for reducing symptoms and preventing complications. The treatment of herpetic folliculitis typically involves the use of antiviral medications, which can help to reduce the severity and duration of symptoms. According to the 2022 study published in Clinical Infectious Diseases 1, several dosing strategies of anti-herpesvirus medications, including acyclovir, famciclovir, and valacyclovir, have been studied and are FDA-approved for the treatment of genital herpes. However, the study suggests that dosing strategies that are most feasible for patient adherence should be prioritized.
Some key points to consider when treating herpetic folliculitis include:
- The use of oral antiviral medications, such as valacyclovir (1 gram twice daily for 7-10 days) or acyclovir (400 mg three times daily for 7-10 days), as first-line treatment options
- The potential need for intravenous acyclovir (5-10 mg/kg every 8 hours) in severe cases or for immunocompromised patients
- The importance of keeping the affected area clean and dry, avoiding sharing personal items, and refraining from touching or scratching lesions to prevent spreading the infection
- The use of cool compresses and over-the-counter pain relievers, such as acetaminophen or ibuprofen, to help manage discomfort
It is also important to note that recurrent episodes of herpetic folliculitis may require suppressive therapy with lower doses of antivirals, as suggested by the 1998 guidelines for treatment of sexually transmitted diseases published in MMWR Recommendations and Reports 1. However, the most recent and highest quality study, published in 2022, should be prioritized when making treatment decisions 1.
From the Research
Herpetic Folliculitis
- Herpetic folliculitis is a condition where the hair follicles become infected with the herpes simplex virus (HSV) 2.
- The clinical presentations of HSV and molluscum contagiosum (MC) are well known to dermatologists, but folliculitis due to these viruses is an infrequently reported entity and might be considered a sign of immunosuppression 2.
- A study published in 2000 described the clinical and histopathological characteristics of viral folliculitis due to HSV and MC, and found that the lesions improved with antihistamines or acyclovir 2.
Treatment Options
- Acyclovir is an effective treatment for herpetic folliculitis, and can be used in conjunction with antihistamines to improve symptoms 2.
- Valacyclovir, a prodrug of acyclovir, has been shown to be effective in the treatment of herpes simplex, herpes zoster, and other viral infections 3, 4, 5.
- Valacyclovir has been compared to acyclovir in several studies, and has been found to be more effective in hastening the healing of zoster-associated pain and postherpetic neuralgia 4, 5.
Management of Recurrent Infections
- Recurrent oral herpes simplex infections can be effectively treated with systemic acyclovir or valacyclovir 6.
- Sunscreen alone (SPF 15 or above) can be effective in preventing recurrent herpes labialis (RHL) in immunocompetent individuals 6.
- Systemic valacyclovir 500 to 2000 mg twice a day can also be effective in preventing RHL in immunocompetent individuals 6.