What is the manifestation of eosinophilic folliculitis?

Updated: Oct 08, 2020
  • Author: Elizabeth K Satter, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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The last noninfectious folliculitis to be discussed is eosinophilic folliculitis. It manifests as intensely pruritic pustules and can occur in at least 3 different clinical situations. The first is the original description of eosinophilic pustular folliculitis, also known as Ofuji disease. It arises in Japanese males at an average age of 30 years. The lesions initially begin as discrete papules and pustules that eventually coalesce to form circinate plaques composed of a peripheral rim of pustules with central clearing; however, granulomatous lesions have also been described. [6] These lesions appear cyclically on the face, back, and extensor surfaces of the arms and spontaneously resolve in 7-10 days. Often, peripheral eosinophilia is present. [13]

A second form of eosinophilic folliculitis arises in patients with AIDS and other conditions that result in immunosuppression. [23] This form is seen most often in adult males with a CD4+ count of less than 300 cells/μL. It is persistent and does not form an annular pattern. The lesions tend to favor the face, scalp, and upper trunk. [4] Eosinophilic folliculitis may also occur after antiretroviral therapy, possibly through macrophage activation. [5]

The last form of eosinophilic folliculitis occurs in infants. It is more common in male infants and usually is self-limited; however, as in Ofuji disease, it may follow a cyclic course lasting months to years. Unlike the adult form, the lesions primarily affect the scalp and eyebrows and are often associated with secondary crusting. This form may also be associated with peripheral eosinophilia.

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