Diagnosed with Folliculitis, have questions.

[youngguy1]

Hello, I am a 24 year old Caucasian Male.
Around 5 years ago I got an outbreak of red bumps on my buttocks out of no where.  I passed these bumps off as an allergic reaction and didn't pay much attention to them.  Since then, these lesions have come and gone but never gone away, and have spread to other parts of my body.  Now, I have these lesions on the back of my arms, front of my shoulders, still my buttocks, my flanks (sides of my trunk), and rarely a few on my fore arms.  After this condition got worse, I began investigating online and thought that I had folliculitis, which I discovered was true just yesterday at the dermatologist.  He prescribed me with clindamycin phosphate lotion.  Much to my dismay, while online I noticed that most websites linked some types of folliculitis with HIV and gave pictures.  I believe it was called eosinophilic folliculitis.  My concern was that the pictures of this type looked much like the other types.  Because of my new found worry, I went out and purchased the Home Access HIV Test.  The results came back negative.  I was a wrestler for 15 years and have had ringworm and impetigo countless times (if that has any relevance?)

Here are my questions.

-Is the medication the doctor put me on for bacterial, fungal, or viral folliculitis?  Also, can a derm. tell be a visual exam which kind it is, or do they prescribe for the most common and then use process of elimination through testing?

-Should I trust this home HIV test (it is the only one that is FDA approved), and should I even be worried about HIV (even though it came back negative), does anything I listed sound like HIV related skin problems?

-Is it common for folliculitis not to go away on its own, and to spread to multiple parts of the body like in my case?

Thanks

[youngguy1]

I don't know if you only get one response with the doctor, but I I imagine that is probably the case.  Anyways, if the Doc gets this; if my folliculitis is not responding to the medicine I was prescribed does that mean it is probably not bacterial, and if it is not should I be worried (if it is viral or fungal)?  I guess it has only been 2 days, but the medicine seems to be doing nothing.

Thanks

[willow569]

It looks like nobody has responded to your new question.  I am not a doctor, but I have read a little bit about fungal folliculitis (have been battling with this myself).  It is caused by a number of different factors - one is having been on antibiotics (it seems to happen sometimes when people have been treated with antibiotics for acne over long periods of time).  I believe that fungal folliculitis happens in these cases because the antibiotics are killing off the bacteria on the skin, which normally resides in balance with a common skin fungus (which is present on most people's skin, but doesn't cause them problems).  My understanding is that when the bacteria are killed off, the fungus is allowed to grow out of control - leading to the folliculitis.  Oral or topical antibiotics can actually make fungal folliculitis worse, so that may be why the clindamycin isn't working for you.  I would go back to your doctor and see if they can evaluate you for the fungal type of folliculitis.  

Other causal factors I have read about are oily skin, warm/humid enviroments, wearing constrictive clothing that doesn't breathe.  

Do a search for this on acne.org - lots of people seem to develop this problem.  My treaments have been moderately effective.  I have used topical Nizoral shampoo, the ZNP cleansing bar, and have also been on an oral medication for yeast infection.  Topical mandelic acid also seems to help somewhat.

[youngguy1]

So it has been about 2 weeks now and the clindamycin has done nothing.  Here is the new situation.  I aquired a spot which I believed was going to be ringworm (as I stated above I wrestled forever and have had ringworm countless times) so I put over the counter Lamisil on it.  The spot where the ringworm was just so happened to be around the same area of some of my folliculitis.  Well, not only has my folliculitis not recessed since I started the clindamycin, but it has just kept coming like I wasn't using the medicine at all.  However, where I have been putting the Lamisil for the ringworm I thought was coming, the folliculitis has almost totally  cleared up in the matter of a day and a half.  My new problem is that now I'm freaked out again.  Everything at all these damn medical websites says that fungal folliculitis is usually due to some immunity problem, and as I stated before, I already took a Home Access HIV test and it came back negative, and I know its been ATLEAST a year since any questionable sexual contact that could possibly cause HIV.  Should I be worried about this....did my HIV test fail?  Or is there some other serious problem that should be looked into?  Any response to this is GREATLY appreciated (Dr.Rockoff).  I know I am being repetitive and probably pretty annoying...I just don't know what to do.
Thanks.

[Alan Rockoff, MD]

Your rash does sound like folliculitis.  This is a very common condition in perfectly healthy people.  You needn't worry about HIV, and the home HIV test corroborates that.  The medicine the doctor gave you is indeed for bacteria, which are involved in ordinary folliculitis.  And yes, it can spread.  You should work with your dermatologist, who seems to have the right idea, and should be able to steer you right.

Best.

Dr. Rockoff