Common skin infections in children: Folliculitis and herpes

Childhood skin infections are commonly seen in both primary care and dermatology practice worldwide. They consume considerable resources and need careful management. However, education and reassurance of patients and parents, combined with simple treatment and self management, play a vital part in successful treatment. We recently reviewed six common childhood skin infections: molluscum contagiosum, cutaneous viral warts, impetigo, tinea capitis, scabies, and head lice. We now review two more skin infections commonly seen in children, des cribing the epidemiology, clinical features, and treatment of each. For conditions with limited evidence, we provide pragmatic advice and recommendations.

Sources and selection criteria

We searched Medline, Embase, and the Cochrane Library by using the terms "folliculitis," and "herpes simplex virus." We included randomised trials, reviews, meta-analyses, and guidelines.

Folliculitis

Folliculitis is a superficial inflammation of the hair follicles. It is common and can occur at any age.¹ It is usually caused by bacteria, particularly Staphylococcus aureus, but can also be caused by Pityrosporum. Persistent bacterial folliculitis can be caused by diabetes, friction from tight jeans, occlusive dressings, and shaving.

Folliculitis begins as inflammation of the follicular ostium and can be pruritic or painful. The lesions develop into 1-5 mm yellow-grey papules or pustules, with surrounding erythema, confined to the follicular ostia (fig 1). They can be grouped or discrete and usually occur on the scalp, face, buttocks, and extremities. There are usually no systemic symptoms.

Uncomplicated folliculitis is managed by removing causative factors and cleansing with topical antiseptics. Antiseptics, including chlorhexidine, triclosan, and povidone-iodine, can be used as creams or lotions, soap substitutes, and bath additives. Emollient-antiseptic combinations, such as Dermol (Dermal Laboratories) and Oilatum Plus (Stiefel Laboratories), may be particularly useful in children to reduce skin irritation.

Resistant lesions respond to topical mupirocin or fusidic acid. Resistance to fusidic acid is increasing, however, and it should be used only for short periods (2 weeks).

For severe or refractory folliculitis, we recommend that systemic antibiotics should be used empirically, as for impetigo, depending on local bacterial resistance patterns and individual tolerability.¹ Gram stain, culture, and sensitivity...