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eosinophilic folliculitis
Idiopathic, pruritic, papular folliculitis of the face, neck & upper body in advanced AIDS
Pathology:
1) perifollicular & perivascular infiltrate of eosinophils
2) epithelial spongiosis of follicular infundibulum &/or sebaceous glands associated with mixed cellular infiltrate
Clinical manifestations:
1) intense pruritus
2) 3-5 mm edematous follicular papules & pustules
3) most patients have hundreds of lesions
4) new lesions are erythematous
5) hyperpigmentation of older excoriated sites
6) distribution: trunk, head (including face), neck, upper extremities
7) changes secondary to stratching
8) secondary infection
9) course of disorder tends to be chronic with exacerbations & remissions
Laboratory:
1) evidence of advanced HIV disease
a) positive HIV1 ELISA & HIV1 western blot
b) high viral load
c) CD4 count generally < 100/mm3
2) eosinophilia
3) skin biopsy: culture & stains for bacteria, fungi & parasites negative
Differential diagnosis:
1) allergic contact dermatitis
2) adverse cutaneous drug reaction
3) atopic dermatitis
4) scabies
5) insect bites
6) acne vulgaris
7) dermatophytic folliculitis
8) bacterial folliculitis
9) fungal folliculitis
Management:
1) antihistamines for symptomatic relief of pruritus
a) diphenhydramine (Benadryl) 25-50 mg PO every 6 hours PRN
b) hydroxyzine (Atarax) 25-50 mg PO every 4-6 hours PRN
2) topical agents
a) fluorinated glucocorticoids
b) permethrin
3) systemic agents
a) prednisone
1] 70 mg followed by a taper of 5 mg/day (14 days)
2] symptomatic relief
3] recurrence may occur
b) isotretinoin (Accutane)
1] 1-2 mg/kg/day (80 mg)
2] 40 mg/day for 2-4 weeks once signs/symptoms have resolved
3] then, 40 mg QOD for 1-2 months (unless symptoms recur)
c) itraconazole (Sporonox) 400 mg/day for 4 weeks
4) UVB phototherapy or sunlight
a) 3 times/week
b) taper treatments as signs/symptoms resolve
c) moderately effective
d) many individuals cannot tolerate phototherapy because of concurrent treatment with photosensitizing agents, i.e. Bactrim
Related
eosinophilia
Specific
eosinophilic pustular folliculitis
General
folliculitis
References
- Color Atlas & Synopsis of Clinical Dermatology, Common
& Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY,
1997, pg 923-25
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998