Eosinophilic Pustular Folliculitis Clinical Presentation
- Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD more...
The distribution tends to be a seborrheic one on the head and the trunk. About a fifth of patients have palmar and/or plantar plaques, which may be the first sign appearing weeks or months before other clinical features.
Lesions are less commonly pruritic with the classic type than in the other 2 forms.
Patients with eosinophilic pustular folliculitis in the classic form have chronically recurrent crops of sterile follicular papulopustules with peripheral extension and central clearing.[11, 12]
Papulopustules with or without plaques tend to favor the face and the trunk as shown below, although the extremities may also be involved. With the classic form, the palms and the soles may also be affected. In children, the scalp, particularly at the vertex, is most frequently involved.
Individual papulopustules may be larger in the classic form, up to 20-50 mm in diameter, rather than the 1-3 mm in diameter seen in patients with HIV disease and in infants; peripheral extension with central clearing may be much less frequent in these 2 forms than in the classic one, which often has an erythematous base. The latter tends to heal more commonly with postinflammatory hyperpigmentation.
No systemic involvement is evident, although a peripheral leukocytosis and eosinophilia may be seen. Atypical features, such as nonfollicular papules and urticarial plaques, are often evident in patients with HIV disease and in infants.
The cause of eosinophilic pustular folliculitis is unknown. Possible etiologies are discussed in Pathophysiology. Reports have described Asian patients in whom eosinophilic pustular folliculitis seemed to be associated with silicone tissue augmentation or autologous peripheral blood stem cell transplantation.
A middle-aged Japanese woman has been described in whom eosinophilic pustular folliculitis was induced by a combination of allopurinol and timepidium bromide as suggested by the results of an oral provocation test with both drugs. Moreover, allopurinol alone seemed to induce generalized eosinophilic pustular folliculitis.
Eosinophilic pustular folliculitis associated with pregnancy has been described.[18, 19]
A middle-aged man with eosinophilic pustular folliculitis apparently associated with hepatitis C virus infection has also been reported.
Hyperimmunoglobulin E syndrome may be evident as eosinophilic pustular folliculitis. Other additional linkages of eosinophilic pustular folliculitis besides HIV infection include the Sézary syndrome.[21, 22]
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