eosinophilic folliculitis
Jump to navigation
Jump to search
Introduction
Idiopathic, pruritic, papular folliculitis of the face, neck & upper body in advanced AIDS
Pathology
- perifollicular & perivascular infiltrate of eosinophils
- epithelial spongiosis of follicular infundibulum &/or sebaceous glands associated with mixed cellular infiltrate
Clinical manifestations
- intense pruritus
- 3-5 mm edematous follicular papules & pustules
- most patients have hundreds of lesions
- new lesions are erythematous
- hyperpigmentation of older excoriated sites
- distribution: trunk, head (including face), neck, upper extremities
- changes secondary to stratching
- secondary infection
- course of disorder tends to be chronic with exacerbations & remissions
Laboratory
- evidence of advanced HIV disease
- positive HIV1 ELISA & HIV1 western blot
- high viral load
- CD4 count generally < 100/mm3
- eosinophilia
- skin biopsy: culture & stains for bacteria, fungi & parasites negative
Differential diagnosis
- allergic contact dermatitis
- adverse cutaneous drug reaction
- atopic dermatitis
- scabies
- insect bites
- acne vulgaris
- dermatophytic folliculitis
- bacterial folliculitis
- fungal folliculitis
Management
- antihistamines for symptomatic relief of pruritus
- diphenhydramine (Benadryl) 25-50 mg PO every 6 hours PRN
- hydroxyzine (Atarax) 25-50 mg PO every 4-6 hours PRN
- topical agents
- systemic agents
- prednisone
- isotretinoin (Accutane)
- 1-2 mg/kg/day (80 mg)
- 40 mg/day for 2-4 weeks once signs/symptoms have resolved
- then, 40 mg QOD for 1-2 months (unless symptoms recur)
- itraconazole (Sporonox) 400 mg/day for 4 weeks
- UVB phototherapy or sunlight
- 3 times/week
- taper treatments as signs/symptoms resolve
- moderately effective
- many individuals cannot tolerate phototherapy because of concurrent treatment with photosensitizing agents, i.e. Bactrim