Complications of Folliculitis in HIV

For a teenager, acne and pimples are simply part of growing up. But as adults, irritating skin conditions can sometimes rear their ugly heads, no more so than in people living with HIV. Among the more common conditions is folliculitis, a skin disorder which can manifest, often profoundly, in HIV-infected people with severely compromised immune systems.

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Causes of Folliculitis

Folliculitis is defined as an inflammation or infection of hair follicles. Folliculitis can occur anywhere there is body hair, but most often appears in areas that are either irritated from shaving, chafed from rubbing clothes, or blocked by oils and dirt in pores. The most common sites of folliculitis are the face, scalp, leg, under the arms, and on the chest and back.

Typically, folliculitis occurs when hair follicles become damaged or obstructed, providing a perfect breeding ground for bacteria or fungus.

Some of the most common infective agents are:

• Staphylococcus aureus is a staph infection
• Sycosis barberis (also known as a Barber's Itch) It is a staphylococcus infection of the hair follicles in the bearded area of the face, usually the upper lip
• Tinea rubrum (a fungal infection)
• Herpes simplex virus (HSV)
• Malassezia is a type of yeast commonly found on the skin and body surfaces.
• Dermatophytes are fungi
• Candida albicans is yeast and is the same type that causes yeast infections.
• Molluscum contagiosum virus

Signs and Symptoms 

Symptoms vary from person to person but usually presents with:

• Reddened rash
• Pus-filled lesions (pustules)
• Crusted lesions that have opened and drained pus
• Itchiness

In cases of eosinophilic folliculitis, these manifestations are often profound and extremely itchy with pustules on the face, neck, scalp, and trunk.

Diagnosing Folliculitis

The diagnosis of folliculitis is generally made by a physical examination of the skin and the lesions. On occasion, a skin biopsy will be performed, although this is usually done to rule out other possible causes. A culture of the lesion may also help reveal if a particular fungus or bacteria has caused the infection.

Treatment Options

If you are affected with folliculitis, you can help minimize the symptoms by taking a couple of simple precautions:

• Wear loose clothes that don't rub directly against the skin. This includes hosiery or elastic socks if you are affected in the lower extremities.
• Try shaving with an electric razor as opposed to a blade razor.
• Keep the skin clean using soap, water, and mild skin cleansers. Avoid exfoliators and scrubs, as well as face masks and strong astringents. Keeping yourself well hydrated will also benefit the skin and can potentially reduce symptoms.

Treatment largely depends on what is causing the infection and how severe it is and can include

• Antibiotic ointments for bacterial infections
• Antifungal creams for fungal infection
• Antibiotic or medicated shampoos for folliculitis of the scalp
• Topical steroids
• Oral antihistamines (ie Benadryl) for itching
• UVB phototherapy
• Isotretinoin

In some cases, the drugs itraconazole and/or permethrin 5.0% cream may be prescribed in tandem with ART for those with more severe manifestations.