eMedicine Specialties > Infectious Diseases > Skin and Soft-Tissue Infections

Eosinophilic Folliculitis: Differential Diagnoses & Workup

Author: Camila K Janniger, MD, Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, New Jersey Medical School
Coauthor(s): Rajendra Kapila, MD, MBBS, Professor of Medicine, Department of Medicine, UMDNJ, New Jersey Medical School; M Angelica Selim, MD, Associate Director of Dermatopathology, Departments of Pathology and Internal Medicine, Assistant Professor, Duke University Medical Center; Christopher R Shea, MD, Professor and Chief, Section of Dermatology, Department of Medicine, University of Chicago
Contributor Information and Disclosures

Updated: Jul 20, 2009

Differential Diagnoses

Candidiasis
Urticaria

Other Problems to Be Considered

Workup

Laboratory Studies

  • In patients with eosinophilic folliculitis, a CBC count reveals leukocytosis and eosinophilia.
  • Immunoelectrophoresis reveals elevated levels of immunoglobulin E (IgE), low levels of immunoglobulin G3 (IgG3), and low levels of immunoglobulin A (IgA) in pediatric eosinophilic folliculitis.
  • Culture of skin lesion reveals no consistent bacterial or fungal growth.
  • The CD4 count is usually less than 250-300 cells/µL in patients infected with HIV who have eosinophilic folliculitis.

Histologic Findings

The infundibulum of the hair follicle manifests eosinophilic spongiosis and pustulosis. The infiltrate often extends to the adjacent sebaceous gland. Although most follicles are preserved, some follicular walls are destroyed by the inflammatory infiltrate. The infiltrate is mainly composed of eosinophils with variable numbers of neutrophils and mononuclear cells. It also manifests a moderately dense, perivascular, and perifollicular inflammatory infiltrate comprised of eosinophils, lymphocytes (mainly CD4+), and macrophages. Follicular mucinosis may be seen in lesions of eosinophilic folliculitis. Special stains are negative for micro-organisms. The lesions of the palms and soles have subcorneal and intraepidermal pustules, accompanied by a variable dermal inflammatory infiltrate.

Eosinophilic folliculitis (low-power). Note eosin...

Eosinophilic folliculitis (low-power). Note eosinophilic spongiosis, particularly involving the infundibular region of the hair follicle.

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Eosinophilic folliculitis (low-power). Note eosin...

Eosinophilic folliculitis (low-power). Note eosinophilic spongiosis, particularly involving the infundibular region of the hair follicle.



Eosinophilic folliculitis (high-power). In additi...

Eosinophilic folliculitis (high-power). In addition to the abundant eosinophils, note the variable numbers of neutrophils and mononuclear cells.

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Eosinophilic folliculitis (high-power). In additi...

Eosinophilic folliculitis (high-power). In addition to the abundant eosinophils, note the variable numbers of neutrophils and mononuclear cells.


More on Eosinophilic Folliculitis

Overview: Eosinophilic Folliculitis
Differential Diagnoses & Workup: Eosinophilic Folliculitis
Treatment & Medication: Eosinophilic Folliculitis
Follow-up: Eosinophilic Folliculitis
Multimedia: Eosinophilic Folliculitis
References
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References

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Further Reading

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Keywords

eosinophilic folliculitis, EF, eosinophilic pustular dermatosis, eosinophilic pustular folliculitis, EPF, Ofuji disease, Ofuji's disease, sterile eosinophilic pustulosis, immunosuppression-associated eosinophilic folliculitis, infancy-associated eosinophilic folliculitis, immunosuppression-associated EF, infancy-associated EF, pediatric eosinophilic folliculitis, infant eosinophilic folliculitis, pediatric EF, infant EF, neonatal eosinophilic folliculitis, neonatal EF, classic eosinophilic folliculitis, classic EF

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Contributor Information and Disclosures

Author

Camila K Janniger, MD, Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, New Jersey Medical School
Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Rajendra Kapila, MD, MBBS, Professor of Medicine, Department of Medicine, UMDNJ, New Jersey Medical School
Rajendra Kapila, MD, MBBS is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, and Infectious Diseases Society of New Jersey
Disclosure: Nothing to disclose.

M Angelica Selim, MD, Associate Director of Dermatopathology, Departments of Pathology and Internal Medicine, Assistant Professor, Duke University Medical Center
Disclosure: Nothing to disclose.

Christopher R Shea, MD, Professor and Chief, Section of Dermatology, Department of Medicine, University of Chicago
Christopher R Shea, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society of Dermatopathology, Arthur Purdy Stout Society, Association of Professors of Dermatology, Chicago Dermatological Society, Dermatology Foundation, Illinois Dermatological Society, International Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Joseph Richard Masci, MD, Chief of Infectious Diseases, Associate Director, Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Elmhurst Hospital Center, Mount Sinai School of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Joseph F John Jr, MD, FACP, FIDSA, FSHEA, Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center
Disclosure: BioMerieux Honoraria Review panel membership; Cubist Honoraria Review panel membership; Pfizer Honoraria Speaking and teaching; Merck Stock dividends stock holdings

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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