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What’s Causing This Man’s Folliculitis Barbae?

  • Authors:
    Aunna Pourang, MD

    Department of Dermatology, University of California, Davis, Sacramento, California, and Faculty Practice Group, University of California, Los Angeles, California

    Simran Sandhu, BS
    School of Medicine, University of California, Davis, Sacramento, California

    Raja K. Sivamani, MD, MS, AP
    Department of Dermatology, University of California, Davis, and Pacific Skin Institute, Sacramento, California

    Pourang A, Sandhu S, Sivamani RK. What’s causing this man’s folliculitis barbae? Consultant. 2020;60(1):19-22. doi:10.25270/con.2020.01.00006


    A healthy 38-year-old man presented to a walk-in clinic for evaluation of a rash on his upper neck that his primary care physician had diagnosed as a possible skin abscess 2 days prior. The patient was concerned that the area was not improving despite his taking cephalexin and using topical mupirocin.

    His symptoms had begun 4 days earlier after he had shaved the ingrown hairs in the area with an older razor while on a business trip. He did not recall any other stress, illness, or other trauma to the area. He described the area as being painful and having “come to a head,” but the lesion was otherwise asymptomatic (Figure 1). He also reported having a similar but milder rash in the same area 8 years prior after having shaved with an old razor, but he did not remember how the area was treated.

    Fig 1
    Figure 1. Initial photo taken by patient before his first office visit to his primary care provider. Vesicles with surrounding erythema were present with a satellite lesion inferiorly.

    On examination, a tender, indurated, vesiculopapular rash was noted at the right inferior aspect of the neck at the beard line (Figure 2). The patient also had tender right anterior and posterior cervical lymphadenopathy.

    Fig 2
    Figure 2. Photo taken at the follow-up visit at the walk-in clinic. Vesicles were more prominent, and induration was present.

    Upon further questioning, the patient reported that while he had no known history of herpes infection, his wife had a history of herpes labialis, with no recent active lesions, but he had not had any recent oral contact in the affected area.

    The patient was started empirically on acyclovir, 400 mg, 3 times a day for 5 days. The affected area was swabbed; polymerase chain reaction (PCR) results returned positive for herpes simplex virus (HSV), but bacterial and fungal cultures came back negative.

    One week later, during telephone follow-up, the patient reported resolution of the pain and that the affected area had crusted over and was healing well (Figure 3).

    Fig 3
    Figure 3. Resolving rash 2.5 weeks after the initial eruption. The vesicles had resolved with crusting, and resolving erythema was present.

    NEXT: Discussion