Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Eosinophilic Pustular Folliculitis Clinical Presentation

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jun 09, 2016
 

History

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.

Next

Physical

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.

A patchy lesion on the cheek in a patient with eos A patchy lesion on the cheek in a patient with eosinophilic pustular folliculitis. Courtesy of Professor T. Nishikawa, Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.

Some patients may have features of coexistent Ofuji disease and eosinophilic lymphoid granuloma (Kimura disease).[13]

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.

Previous
Next

Causes

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[14] or autologous peripheral blood stem cell transplantation.[15]

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.[16] Moreover, allopurinol alone seemed to induce generalized eosinophilic pustular folliculitis.[17]

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.[4]

Hyperimmunoglobulin E syndrome may be evident as eosinophilic pustular folliculitis.[20] Other additional linkages of eosinophilic pustular folliculitis besides HIV infection include the Sézary syndrome.[21, 22]

Previous
 
 
Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Marian Dmochowski, MD, PhD Professor, Autoimmune Blistering Dermatoses Section, Department of Dermatology, University School of Medicine at Poznan, Poland

Marian Dmochowski, MD, PhD is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Takeji Nishikawa, MD Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc

Disclosure: Nothing to disclose.

References
  1. Ise S, Ofuji S. Subcorneal pustular dermatosis. A follicular variant?. Arch Dermatol. 1965 Aug. 92(2):169-71. [Medline].

  2. Ofuji S, Ogino A, Horio T, Oseko T, Uehara M. Eosinophilic pustular folliculitis. Acta Derm Venereol. 1970. 50(3):195-203. [Medline].

  3. Boone M, Dangoisse C, André J, Sass U, Song M, Ledoux M. Eosinophilic pustular folliculitis in three atopic children with hypersensitivity to Dermatophagoides pteronyssinus. Dermatology. 1995. 190(2):164-8. [Medline].

  4. Gul U, Kilic A, Demiriz M. Eosinophilic pustular folliculitis: the first case associated with hepatitis C virus. J Dermatol. 2007 Jun. 34(6):397-9. [Medline].

  5. Vakilzadeh F, Suter L, Knop J, Macher E. Eosinophilic pustulosis with pemphigus-like antibody. Dermatologica. 1981. 162(4):265-72. [Medline].

  6. Nunzi E, Parodi A, Rebora A. Ofuji's disease: high circulating titers of IgG and IgM directed to basal cell cytoplasm. J Am Acad Dermatol. 1985 Feb. 12(2 Pt 1):268-73. [Medline].

  7. Takematsu H, Tagami H. Eosinophilic pustular folliculitis. Studies on possible chemotactic factors involved in the formation of pustules. Br J Dermatol. 1986 Feb. 114(2):209-15. [Medline].

  8. Maruo K, Kayashima KI, Ono T. Expression of neuronal nitric oxide synthase in dermal infiltrated eosinophils in eosinophilic pustular folliculitis. Br J Dermatol. 1999 Mar. 140(3):417-20. [Medline].

  9. Nomura T, Katoh M, Yamamoto Y, Kabashima K, Miyachi Y. Eosinophilic pustular folliculitis: The transition in sex differences and interracial characteristics between 1965 and 2013. J Dermatol. 2015 Feb 10. [Medline].

  10. Lee WJ, Won KH, Won CH, Chang SE, Choi JH, Moon KC, et al. Facial and extrafacial eosinophilic pustular folliculitis: a clinical and histopathological comparative study. Br J Dermatol. 2014 May. 170(5):1173-6. [Medline].

  11. Kostler E, Gossrau G, Kuster P, Bergner V, Seebacher C. [Sterile eosinophilic pustulosis (Ofuji). A rare entity in Europe]. Hautarzt. 1995 Sep. 46(9):643-6. [Medline].

  12. Weber L, Hochsattel R, Hesse G, Klein CE. [Sterile eosinophilic pustulosis (Ofuji)]. Hautarzt. 1988 Aug. 39(8):527-30. [Medline].

  13. Kudejko J, Jablonska S, Chorzelski T. [Cutaneous changes combining features of Kimura's disease and Ofuji's disease (folliculitis pustulosa eosinophilica). A new disease entity?]. Przegl Dermatol. 1981 Jul-Aug. 68(4):487-95. [Medline].

  14. Wong TW, Tsai YM, Lee JY, Hsu ST, Sheu HM. Eosinophilic pustular folliculitis (Ofuji's disease) in a patient with silicone tissue augmentation. J Dermatol. 2004 Sep. 31(9):727-30. [Medline].

  15. Keida T, Hayashi N, Kawashima M. Eosinophilic pustular folliculitis following autologous peripheral blood stem-cell transplantation. J Dermatol. 2004 Jan. 31(1):21-6. [Medline].

  16. Maejima H, Mukai H, Hikaru E. Eosinophilic pustular folliculitis induced by allopurinol and timepidium bromide. Acta Derm Venereol. 2002. 82(4):316-7. [Medline].

  17. Ooi CG, Walker P, Sidhu SK, Gordon LA, Marshman G. Allopurinol induced generalized eosinophilic pustular folliculitis. Australas J Dermatol. 2006 Nov. 47(4):270-3. [Medline].

  18. Mabuchi T, Matsuyama T, Ozawa A. Case of eosinophilic pustular folliculitis associated with pregnancy. J Dermatol. 2011 May 4. [Medline].

  19. Matsudate Y, Miyaoka Y, Urano Y. Two cases of eosinophilic pustular folliculitis associated with pregnancy. J Dermatol. 2016 Feb. 43 (2):218-9. [Medline].

  20. Lo CS, Yang CY, Ko JH, Lee WY, Shih IH, Lin YC. Hyperimmunoglobulin E syndrome presenting as eosinophilic pustular folliculitis: a case report. Int J Dermatol. 2015 Feb. 54(2):211-4. [Medline].

  21. Sugaya M, Suga H, Miyagaki T, Fujita H, Sato S. Eosinophilic pustular folliculitis associated with Sézary syndrome. Clin Exp Dermatol. 2014 Jun. 39(4):536-8. [Medline].

  22. Takashima S, Nishie W, Morita Y, Osawa R, Iwata H, Fujita Y, et al. Eosinophilic pustular folliculitis in a patient with mycosis fungoides. J Eur Acad Dermatol Venereol. 2015 Feb 11. [Medline].

  23. Takamura S, Teraki Y. Eosinophilic pustular folliculitis associated with hematological disorders: A report of two cases and review of Japanese literature. J Dermatol. 2016 Apr. 43 (4):432-5. [Medline].

  24. Lee ML, Tham SN, Ng SK. Eosinophilic pustular folliculitis (Ofuji's disease) with response to indomethacin. Dermatology. 1993. 186(3):210-2. [Medline].

  25. Miyauchi T, Fujigaki T, Uehara M, et al. Successful treatment of eosinophilic pustular folliculitis with indomethacin. Acta Dermatol Kyoto. 1985. 80:9-13.

  26. Nishijima S, Sugiyama T, Nakagawa M, Odaka T, Takaishi K. Two cases of eosinophilic pustular folliculitis treated by acemetacin. J Dermatol. 1994 Oct. 21(10):779-82. [Medline].

  27. Brazzelli V, Barbagallo T, Prestinari F, Ciocca O, Vassallo C, Borroni G. HIV seronegative eosinophilic pustular folliculitis successfully treated with doxicycline. J Eur Acad Dermatol Venereol. 2004 Jul. 18(4):467-70. [Medline].

  28. Hashizume S, Ansai S, Kosaka M, Kawana S. Infantile case of eosinophilic pustular folliculitis successfully treated with topical indomethacin. J Dermatol. 2014 Feb. 41(2):196-7. [Medline].

  29. Yamamoto Y, Nomura T, Kabashima K, Miyachi Y. Clinical epidemiology of eosinophilic pustular folliculitis: results from a nationwide survey in Japan. Dermatology. 2015. 230(1):87-92. [Medline].

  30. Jin SP, Park SY, Yeom KB, Kim YC, Cho KH. Eosinophilic pustular folliculitis involving labial mucosa, which improved with naproxen. Ann Dermatol. 2013 Feb. 25(1):120-2. [Medline]. [Full Text].

  31. Lim HL, Chong WS. Recalcitrant eosinophilic pustular folliculitis of Ofuji with palmoplantar pustulosis: dramatic response to narrowband UVB phototherapy. Photodermatol Photoimmunol Photomed. 2012 Aug. 28(4):219-21. [Medline].

  32. Buchness MR, Lim HW, Hatcher VA, Sanchez M, Soter NA. Eosinophilic pustular folliculitis in the acquired immunodeficiency syndrome. Treatment with ultraviolet B phototherapy. N Engl J Med. 1988 May 5. 318(18):1183-6. [Medline].

  33. Lim HW, Vallurupalli S, Meola T, Soter NA. UVB phototherapy is an effective treatment for pruritus in patients infected with HIV. J Am Acad Dermatol. 1997 Sep. 37(3 Pt 1):414-7. [Medline].

  34. Nomura T, Katoh M, Yamamoto Y, Miyachi Y, Kabashima K. Eosinophilic pustular folliculitis: Trends in therapeutic options. J Dermatol. 2016 Feb 15. [Medline].

  35. Nomura T, Katoh M, Yamamoto Y, Miyachi Y, Kabashima K. Eosinophilic pustular folliculitis: A proposal of diagnostic and therapeutic algorithms. J Dermatol. 2016 Mar 30. [Medline].

  36. Hernández-Martín Á, Nuño-González A, Colmenero I, Torrelo A. Eosinophilic pustular folliculitis of infancy: a series of 15 cases and review of the literature. J Am Acad Dermatol. 2013 Jan. 68(1):150-5. [Medline].

  37. Wilson BD, Kucera JC, Shin PJ. The role of radiation treatment in the management of eosinophilic pustular folliculitis. J Med. 2002. 33(1-4):111-3. [Medline].

  38. Toyonaga E, Abe R, Moriuchi R, Ito K, Abe Y, Shimizu H. Indomethacin for refractory infantile eosinophilic pustular folliculitis. JAMA Dermatol. 2013 Mar. 149(3):367-8. [Medline].

  39. Kawaguchi M, Mitsuhashi Y, Kondo S. Successful treatment of eosinophilic pustular folliculitis with topical tacrolimus. Int J Dermatol. 2004 Aug. 43(8):608-10. [Medline].

  40. Patel NP, Laguda B, Roberts NM, Francis ND, Agnew K. Treatment of eosinophilic pustulosis of infancy with topical tacrolimus. Br J Dermatol. 2012 Nov. 167(5):1189-91. [Medline].

  41. Rho NK, Kim BJ. Eosinophilic pustular folliculitis: successful treatment with topical pimecrolimus. Clin Exp Dermatol. 2007 Jan. 32(1):108-9. [Medline].

  42. Kanekura T, Mera Y, Mera K, Saruwatari H, Kanzaki T. Efficacy of transdermal nicotine patches for eosinophilic pustular folliculitis. Br J Dermatol. 2005 May. 152(5):1074-5. [Medline].

  43. Satoh T, Shimura C, Miyagishi C, Yokozeki H. Indomethacin-induced reduction in CRTH2 in eosinophilic pustular folliculitis (Ofuji's disease): a proposed mechanism of action. Acta Derm Venereol. 2010. 90(1):18-22. [Medline].

  44. Fukamachi S, Kabashima K, Sugita K, Kobayashi M, Tokura Y. Therapeutic effectiveness of various treatments for eosinophilic pustular folliculitis. Acta Derm Venereol. 2009. 89(2):155-9. [Medline].

  45. Sugita K, Kabashima K, Koga C, Tokura Y. Eosinophilic pustular folliculitis successfully treated with sequential therapy of interferon-gamma and ciclosporin. Clin Exp Dermatol. 2006 Sep. 31(5):709-10. [Medline].

  46. Otsuka A, Doi H, Miyachi Y, Kabashima K. Treatment of eosinophilic pustular folliculitis with ciclosporin: suppression of mRNA expression of IL-4 and IL-13. J Eur Acad Dermatol Venereol. 2010 Dec. 24(12):1489-91. [Medline].

 
Previous
Next
 
A patchy lesion on the cheek in a patient with eosinophilic pustular folliculitis. Courtesy of Professor T. Nishikawa, Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
Widespread hyperpigmented patches on the back and the arms in a patient with eosinophilic pustular folliculitis. Courtesy of Professor T. Nishikawa, Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
A 51-year-old Japanese man without a concomitant HIV infection with pustular eosinophilic folliculitis. Courtesy of Professor Akimichi Morita, Nagoya City University Medical School, Nagoya, Japan.
Transverse section from a 21-year-old man with eosinophilic pustular folliculitis. A perifollicular inflammatory infiltrate containing numerous eosinophils is present (hematoxylin and eosin, original magnification X400).
Vertical section from a 3-year-old girl with eosinophilic pustular folliculitis. A perifollicular inflammatory infiltrate containing eosinophils is present (hematoxylin and eosin, original magnification X200).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.