Facial Herpetic Folliculitis Should Be Concerned in the Clinic: A Retrospective Case Series

BACKGROUND: Herpetic folliculitis (HF) is a rare manifestation of herpes virus infection of the skin, which has different presentations causing frequent misdiagnosis. Previous literature has reported follicular infections caused by herpes simplex virus (HSV) in the beard area, called herpetic sycosis, but only a few cases presented facial extensive folliculitis. PURPOSE: This case series aimed to describe the clinical features of facial generalized herpetic folliculitis. METHODS: We retrospectively collected a case series of 20 patients with facial diffused herpetic folliculitis diagnosed clinically or experimentally from outpatients between 2012 and 2022. The reported cases similar to HF of literature were concluded. RESULTS: There were 19 females and 1 male in this study. Disease duration varied from 1 to 10 days, and lesion manifestations were predominantly papules and maculopapules. Most patients suffered spontaneous pain or pruritus and recovered with antiviral treatment. All cases achieved great improvements in lesions after antiviral and topical medication therapy. CONCLUSION: This case series suggests that in patients with infectious folliculitis of the face when the lesions develop acutely and diffusely, dermatologists should take into account the possibility of herpetic folliculitis, especially in cases where antibacterial or antifungal therapy is resistant, and actively administer antiviral therapy after diagnosis.