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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 [1] 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 [2] Clinical manifestations: - crops of follicular papules on back, face, chest, & upper arms - pruritic papulues - pustules uncommon - clustered in areas of sebaceous glands * images [2] 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

General

eosinophilic folliculitis

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  2. Schwartz RA, Elston DM (images) Medscape: Eosinophilic Pustular Folliculitis http://emedicine.medscape.com/article/1070326-overview
  3. DermNet NZ. Eosinophilic folliculitis (images) http://www.dermnetnz.org/acne/eosinophilic-folliculitis.html
  4. Nervi SJ, Schwartz RA, Dmochowski M Eosinophilic pustular folliculitis: a 40 year retrospect. J Am Acad Dermatol. 2006 Aug;55(2):285-9 PMID: 16844513