Folliculitis or herpes?

[BabyBlueWhale]

Dear Dr. Handsfield,

My question is similar to one on this site, but I need to ask it anyway to ease my mind.  I hope you don't mind.  Anyway, recently I went to my doctor with a scab on the left side of my vulua region.  He diagnosed me with folliculitis from what I said and from what he saw when he looked at the area.  But he was in a rush and did not have time to answer all of my questions and concerns.  Anyway, since then I have been reading on the web about folliculitis and now I am afraid that I have herpes.  The reason is because from what I read I noticed that folliculitis does not go away for a few weeks, and my symptoms went from bump to pustule to burst/popped pimple in about 2-3 days (I am not really sure how long exactly).  So, my sympotoms cleared up pretty quickly, which is common in herpes.  

So, my question is, can folliculitis last only a few days before a scab is formed?  Is that possible or not possible?

Thank you so much for answering this!

Best,
Lee

[ryn21]

http://dermatlas.med.jhmi.edu/derm/

Go to the site I have listed above, click on index, then click on folliculitis.  There are some good illustrations on that site.  That site is awesome as far as illustrations for many skin conditions, including herpes.  There are tons of pictures.  

Do not however diagnose your problem based on pictures and information found internet.

[H. Hunter Handsfield, M.D.]

Sorry, but it clutters up the forum to start a new thread rather than continuing a previous one.  I am responding to your new question here, and will delete the new one.

I did not conclude you have herpes rather than folliculitis (or just a zit).  The additional information you provide slightly favors a pimple rather than herpes, but I can't comment further on whether you have herpes or not,  Your sexual history doesn't help much; it indicates you have been sexually active enough to get an HSV-2 infection, but so has everybody else with more than 1 lifetime sex partner.

You need to follow the advice in my original response:  Ask the doc who diagnosed folliculitis how sure he of the diagnosis; and consider having an HSV-2 blood test.  (See numerous other threads about the right kind of blood test to request; some labs still perform outdated, unreliable tests.  Search the threads for "HerpeSelect".)  But in the meantime, don't panic; you may not have herpes, and if you do, it is manageable.  Not fun, but usually not a big deal for most infected people.

Best wishes---  HHH, MD

[ryn21]

I think if it were herpes, your GP would have been able to diagnose it as such.  Folliculitis can come and go in different timeframes, not just in weeks.  Ingrown hairs can form a pimple like bump, pop, and scab over in just a few days.  So I doubt you have anything to really worry about.  I know how docs are, always in a rush, dont give you enough time to answer questions.  However most docs are probably pretty good at distinguishing between Folliculitis and Herpes.  So if he said you had folliculitis, thats probably what it is.  Its common.  Dont worry about it, but if your anxiety is still getting the best of you, have your GP test you for herpes, (ie Herpeselect Test), although i think its unneccessary.

[H. Hunter Handsfield, M.D.]

I wish I could help, but from your description I simply can't say much.  If the lesion was in a hair-bearing area, folliculitis probably is statistically more likely than herpes; but if on your labia minor or inside the hair-bearing area of your labia major, herpes could still be possible.  Folliculitis (basically, a pimple) tends to deeper in the skin, like most pimples, whereas herpes lesions are quite superficial, sort of sitting "on" rather than "in" the skin; perhaps that is a helpful clue.  Folliculitis can go away within a few days, so that really isn't helpful.  (Chronic, recurrent folliculitis is difficult to treat, perhaps explaining the "few weeks" information you found.  But that's only a guess.)  I often suggest patients rely on their providers' diagnosis--but many doctors tend to under-diagnose herpes, and considering all genital inflammatory lesions, herpes is overall the most common cause.

So....   if you have any continuing doubt about herpes, you may want to have an HSV-2 blood test to be sure.  This is especially a good idea if 1) a similar lesion appears again in the future, in more or less the same spot; 2) you consider yourself at risk for STDs (multiple partners, recent partner change, partner at risk); 3) or you have ever had a partner with genital herpes.

You came here looking and hoping for reassurance, and I fear I may have done the opposite.  Best wishes--

HHH, MD