Which histologic findings are characteristic of herpes folliculitis?

Updated: Oct 08, 2020
  • Author: Elizabeth K Satter, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

The histopathological evaluation of herpes folliculitis can be subtle and nonspecific and often requires that deeper histological sections are obtained in order to see the characteristic histological changes. Typically, a dense lymphohistiocytic infiltrate is noted, often admixed with neutrophils that surround and frequently destroy the hair follicle. The characteristic changes of a herpes infection, namely balloon degeneration of the keratinocytes of the follicle, scattered multinucleated cells, and keratinocytes with enlarged gray nuclei that have peripheral margination of the chromatin, are seen in approximately half the cases on which a biopsy has been performed. Most cases of herpes folliculitis have been shown to be caused by a varicella-zoster infection, and, initially, the infection is centered on the sebaceous gland. [19]


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