eosinophilic pustular folliculitis

Classification

• classic eosinophilic pustular folliculitis
• HIV-associated eosinophilic pustular folliculitis
• infantile eosinophilic pustular folliculitis

Etiology

• hyperreactivity to dermatophytes or saprophytic fungi in association with a disordered immune system (hypothesis)
• Demodex +/- Pityrosporum possible trigger
• disease associations
  • hyperimmunoglobulin E syndrome
  • HIV1 infection
  • hepatitis C infection
  • Sezary syndrome
• drugs: allopurinol

Epidemiology

• common

Pathology

• noninfectious eosinophilic infiltration of hair follicles
• histologic subcorneal pustulosis of the upper hair follicles
• palms & soles may be affected where there are no hair follicles

* histopathology images

Clinical manifestations

• crops of follicular papules on back, face, chest, & upper arms
• pruritic papulues
• pustules uncommon
• clustered in areas of sebaceous glands

* images

Laboratory

• complete blood count (CBC)
  • relative eosinophila (8-9%)
• CD4 count often < 300/uL (HIV1 infection)
• serum immunoglobulin E may be elevated
• skin swabs for microscopy & culture
• scrapings for mycologic analysis
• skin biopsy

Management

• classic form
  • indomethacin (topical or oral)
    • naproxen may be alternative
  • topical tacrolimus, topical pimecrolimus, nicotine patch
  • phototherapy: UVB or UVA plus psoralen
• HIV-associated disease
  • topical itraconazole with HIV-associated disease
  • cetirizine or cyproheptadine for pruritus
  • antiretroviral therapy

More general terms

• eosinophilic folliculitis