Eosinophilic folliculitis

Eosinophilic folliculitis (EF) is an itchy rash with an unknown cause which is most common among individuals with HIV, though it can occur in normal individuals where it is known by the eponym Ofuji disease.^[1] 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.

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Epidemiology

Eosinophilic folliculitis associated with HIV infection typically affects individuals with advanced HIV and low T helper cell counts.^[2] 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.^[3] It may also affect otherwise normal infants in a self-limited form.^[4] Finally, normal individuals can also develop EF — this is more common in Japan.^[5]

Pathophysiology

The cause of EF is unknown. A variety of microorganisms have been implicated, including the mite Demodex^[6], the yeast Pityrosporum^[7], and bacteria.^[8] An autoimmune process has also been investigated.^[9]

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.^[10]

References

1. ^ Ofuji, S, Ogino, A, Horio, T, et al. Eosinophilic pustular folliculitis. Acta Derm Venereol 1970; 50:195. PMID: 4193219
2. ^ Parker SR, Parker DC, McCall CO. Eosinophilic folliculitis in HIV-infected women: case series and review. Am J Clin Dermatol. 2006;7(3):193-200. PMID 16734507
3. ^ Leukaemia-associated eosinophilic folliculitis (Ofuji's disease). J Eur Acad Dermatol Venereol. 2004 Sep;18(5):596-8. PMID 15324404
4. ^ Neonatal eosinophilic pustular folliculitis. Clin Exp Dermatol. 2001 May;26(3):251-5. PMID 11422167
5. ^ Skin diseases described in Japan 2004. J Dtsch Dermatol Ges. 2005 Jan;3(1):9-25. Review. PMID 16353745
6. ^ Papular eruption in AIDS: role of demodectic mites? Acta Derm Venereol. 1994 Jul;74(4):320-2. PMID 7976100
7. ^ Ferrandiz C, Ribera M, Barranco JC, Clotet B, Lorenzo JC. Eosinophilic pustular folliculitis in patients with acquired immunodeficiency syndrome. Int J Dermatol. 1992 Mar;31(3):193-5. PMID 1568818
8. ^ Metronidazole for eosinophilic pustular folliculitis in human immunodeficiency virus type 1-positive patients. Arch Dermatol. 1995 Sep;131(9):1089-91. No abstract available. PMID 7661619
9. ^ Itchy folliculitis and human immunodeficiency virus infection: clinicopathological and immunological features, pathogenesis and treatment. Br J Dermatol. 1999 Jul;141(1):3-11. Review. PMID 10417509
10. ^ Ellis E, Scheinfeld N. Eosinophilic pustular folliculitis: a comprehensive review of treatment options. Am J Clin Dermatol. 2004;5(3):189-97. Review. PMID 15186198