Eosinophilic folliculitis

Eosinophilic folliculitis
Classification and external resources
eMedicine	med/687

Eosinophilic folliculitis (also known as "Eosinophilic pustular folliculitis" and "Sterile eosinophilic pustulosis"^[1]) is an itchy rash with an unknown cause that is most common among individuals with HIV, though it can occur in HIV-negative individuals where it is known by the eponym Ofuji disease.^[2] EF consists of itchy red bumps (papules) centered on hair follicles and typically found on the upper body, sparing the abdomen and legs. The name eosinophilic folliculitis refers to the predominant immune cells associated with the disease (eosinophils) and the involvement of the hair follicles.

Epidemiology

Eosinophilic folliculitis associated with HIV infection typically affects individuals with advanced HIV and low T helper cell counts.^[3] It affects both men and women as well as children with HIV and is found throughout the world.

EF may also affect individuals with hematologic disease such as leukemia and lymphoma.^[4] It may also affect otherwise normal infants in a self-limited form.^[5] HIV-negative individuals can also develop EF — this is more common in Japan.^[6]

Pathophysiology

The cause of EF is unknown. A variety of microorganisms have been implicated, including the mite Demodex,^[7] the yeast Pityrosporum,^[8] and bacteria.^[9] An autoimmune process has also been investigated.^[10]

Diagnosis

Eosinophilic folliculitis may be suspected clinically when an individual with HIV exhibits the classic symptoms. The diagnosis can be supported by the finding of eosinophilia but a skin biopsy is necessary to establish it. Skin biopsies reveal lymphocytic and eosinophilic inflammation around the hair follicles.

Treatment

Treatment of eosinophilic folliculitis in people with HIV typically begins with the initiation of Highly Active Anti-Retroviral Therapy in order to help reconstitute the immune system. Direct treatment of the EF itself focuses on decreasing the inflammation and itching. Topical corticosteroids and oral antihistamines can alleviate the itching and decrease the size and number of lesions. Treatment with the antifungal drug itraconazole, the antibiotic metronidazole, and the anti-mite drug permethrin may lead to some improvement of symptoms. Other therapies include PUVA, topical tacrolimus, and isotretinoin.^[11]

See also

• Eosinophilic pustular folliculitis of infancy
• List of cutaneous conditions

References

1. ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
2. ^ Ofuji, S; Ogino, A; Horio, T; Oseko, T; Uehara, M (1970). "Eosinophilic pustular folliculitis". Acta dermato-venereologica 50 (3): 195–203. PMID 4193219. 
3. ^ Parker, SR; Parker, DC; McCall, CO (2006). "Eosinophilic folliculitis in HIV-infected women: case series and review". American journal of clinical dermatology 7 (3): 193–200. doi:10.2165/00128071-200607030-00006. PMID 16734507. 
4. ^ Patrizi, A; Chieregato, C; Visani, G; Morrone, P; Patrone, P (2004). "Leukaemia-associated eosinophilic folliculitis (Ofuji's disease)". Journal of the European Academy of Dermatology and Venereology : JEADV 18 (5): 596–8. doi:10.1111/j.1468-3083.2004.00982.x. PMID 15324404. 
5. ^ Buckley, DA; Munn, SE; Higgins, EM (2001). "Neonatal eosinophilic pustular folliculitis". Clinical and experimental dermatology 26 (3): 251–5. doi:10.1046/j.1365-2230.2001.00807.x. PMID 11422167. 
6. ^ Teraki, Y; Nishikawa, T (2005). "Skin diseases described in Japan 2004". Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG 3 (1): 9–25. doi:10.1046/j.1439-0353.2005.04076.x. PMID 16353745. 
7. ^ Bodokh, I; Lacour, JP; Perrin, C; Bourdet, JF; Ortonne, JP (1994). "Papular eruption in AIDS: role of demodectic mites?". Acta dermato-venereologica 74 (4): 320–2. PMID 7976100. 
8. ^ Ferrándiz, C; Ribera, M; Barranco, JC; Clotet, B; Lorenzo, JC (1992). "Eosinophilic pustular folliculitis in patients with acquired immunodeficiency syndrome". International journal of dermatology 31 (3): 193–5. doi:10.1111/j.1365-4362.1992.tb03934.x. PMID 1568818. 
9. ^ Smith, KJ; Skelton, HG; Yeager, J; Ruiz, N; Wagner, KF (1995). "Metronidazole for eosinophilic pustular folliculitis in human immunodeficiency virus type 1-positive patients". Archives of dermatology 131 (9): 1089–91. doi:10.1001/archderm.131.9.1089. PMID 7661619. 
10. ^ Fearfield, LA; Rowe, A; Francis, N; Bunker, CB; Staughton, RC (1999). "Itchy folliculitis and human immunodeficiency virus infection: clinicopathological and immunological features, pathogenesis and treatment". The British journal of dermatology 141 (1): 3–11. doi:10.1046/j.1365-2133.1999.02914.x. PMID 10417509. 
11. ^ Ellis, E; Scheinfeld, N (2004). "Eosinophilic pustular folliculitis: a comprehensive review of treatment options". American journal of clinical dermatology 5 (3): 189–97. PMID 15186198.