Boil or herpes?

[billbail]

Hello. I'll try to provide some good detail about my question.  I recently had a boil high on my thigh that had a pea sized abscess. It occurred at the site of a follicle I was picking at.  It came to a head about a week ago and is healed over, but still a little red.

Also, about 2 and a half weeks ago, I trimmed my pubic hairs with scissors down to about half an inch. I had never done this before, and the hairs poked and itched incessantly for several days. Then, a few days after trimming, I noticed a few hair follicles in the top edge of my pubic area were a little red. Last Thursday a small abscess developed under one of the follicles and the hair fell out. Over the weekend it became hard and tender growing to the size of a pencil eraser. Yesterday, it came to a head and white puss and blood came out when squeezed.  Today it is healing over and still has a firm (but smaller) lump underneath. It is causing me a lot of anxiety because of the location. I worry it may be an STD, but it didn't look like HSV to me. The last time I was sexually active was with a condom about 3 months ago. I have never had any sore(s)/ulcerations like this in the groin area previously.

Questions:
1. Does this sound like another boil or HSV?  I have read a lot of other posts and it seems that HSV is unlikely to occur in this fashion.
2. Is it unusual to have two boils within a week of each other?  

[Edward W Hook, MD]

Thanks for the follow-up.  I agree that your rash on both thighs is almost certainly not herpes.  In addition to a reaction to benzyl peroxide, it could also be a fungal infection which you become vulnerable to because of the benzl peroxide.

Your plan to stop intensive self-examination and move forward is just the right thing to do.  EWH

[billbail]

So I think this odyssey is mostly done and my anxiety is subsiding.  I thought I would share the before and after stories.  

1. About 3 weeks (late March) after my last protected sexual encounter I noticed some red bumps spread across lower abdomen and some on the thighs and stomach.  I was unable to see a doctor at the time due to travel, but after way too much reading, it was probably either folliculitis or a molluscum outbreak.  No blisters and an unlikely location for herpes.  Also, I kept getting new bumps.  A few that I popped produced a white core and bled vigorously for about 10 minutes.  Others I popped and they just bled similarly.

2. Once of these became infected and resulted in my first boil.  That's when I started getting a lot of anxiety and I trimmed my pubic hair has described in the initial question.  That was the wrong thing to do and caused a second boil to occur.

3. I remained obsessed with bumps on my thigh which would pop up.  I eventually put 10% benzoyl peroxide across a large area of both thighs and that was again the wrong thing to do.  Both thighs broke out in a rash in reaction to the benzoyl peroxide.  I know this because the rash in the precise locations I used the medicine.  I applied a good lotion and it healed in about a week.

4. The strange occurrence was as this rash was healing, I had a secondary rash occur just above this area on both thighs.  The rash was about 1" around on both thighs and rather symmetrical.  Meaning it was about the same height about an inch or so to the outside of the groin fold on both thighs.  It was a group of raised, soft lesions but no blisters.  It almost looked like a mild poison ivy rash.  About 10 days later, this is now healed over and all I see are a handful of dots left.  

As I have read, I think it would be very rare (if not impossible) to have a herpes rash on both thighs at the same time.  That is because if I had herpes, recurrent herpes does not cross the mid-line.  I am just assuming this is some sort of extended reaction to the the benzoyl peroxide because the skin was still sensitive.  Am I correct that this also doesn't sound anything like herpes?

So where am I now?  I am getting better and not studying my thighs and realizing that these random bumps that show up just tend to disappear on their own after about a week.  I'm also going to stop reading about this and looking at pictures online.

[Edward W Hook, MD]

Thanks for the follow-up.  Take care.  EWH

[billbail]

Thank you for your insight.  I applied an over the counter moisturizer to the small rash because the skin appeared dry.  After just two days, nearly all the redness has subsided.  Most of the small bumps are gone.  The few that are left can only be seen with a magnifying glass.  It seems like it was just a reaction along with some dry skin.

The boil is healed over and still red.  I imagine that redness will persist for another few weeks.

[Edward W Hook, MD]

As you know, I cannot make a diagnosis over the internet however what you describe may be additonal folliculitis lesions. there presence around hair follicles is typical. EWH

[billbail]

It is a week later and I now have a small red dotted rash about the size of two postage stamps just above the boil.  2/3 of the dots are at hair follicles.  I have been putting benzoyl peroxide on the boil to help it dry up.  Could this be a reaction to the benzoyl peroxide?

[Edward W Hook, MD]

Welcome to our Forum.  The description that you provide is a perfect description of folliculitis and skin abscesses resulting from the process.  Folliculitis occurs when the pores in your skin get plugged.  Shaving hairy areas (or cutting the hairs shortly as you did) not uncommonly leads to folliculitis. This allows that normal bacteria that are present on just about every-one's skin to grow and cause what is essentially a pimple.  Some of these just appear as red bumps which may or may not be  tender while others go on to actually form pimples containing pus that can be expressed.  In some instances, if you look closely you can see a hair coming out of, or nearby the bump- this too is typical of folliculitis).

This sounds nothing like herpes and you history is not consistent with HSV either.  

In answer to your specific questions:
1. Does this sound like another boil or HSV?  I have read a lot of other posts and it seems that HSV is unlikely to occur in this fashion.

See above. In addition, this would be an unusual location for herpes.  

2. Is it unusual to have two boils within a week of each other?

No, in fact it is common for them to occur together.

I hope these comments are helpful.  I see no reason to worry about (or test for) herpes related to the events you describe. EWH