Eosinophilic Folliculitis Treatment & Management

  • Author: Camila K Janniger, MD; Chief Editor: Michael Stuart Bronze, MD   more...
 
Updated: May 2, 2011
 

Medical Care

Numerous topical and systemic therapies are available for eosinophilic folliculitis. Treatment modalities are chosen based on disease severity, patient preference (including cost and convenience), and response. Highly active antiretroviral therapy along with isotretinoin therapy is beneficial for eosinophilic folliculitis in the setting of HIV disease.[17] Eosinophilic folliculitis may also respond well to systemic indomethacin.[18] A number of therapeutic options are delineated below.

Topical corticosteroids are the mainstay of treatment for eosinophilic folliculitis. The mechanism of action of corticosteroids in eosinophilic folliculitis is not fully understood; the anti-inflammatory and immunosuppressive properties of these agents may contribute to their effect.

The potency of the steroid prescribed depends on the location of the skin lesions. In the scalp, potent steroids in alcohol solution, such as fluocinonide 0.05%, are frequently indicated. On the face and other sensitive body sites, a low-potency cream, such as hydrocortisone 1%, may suffice.

The typical regimen consists of twice-daily application of topical corticosteroids. This decreases the inflammation and plaques in most patients. Skin atrophy due to topical corticosteroid use is usually not a problem unless the medication is continuously applied after the skin has normalized. Severe flares may be treated with short courses of oral prednisone.

Fukamachi et al evaluated the therapeutic effectiveness of various treatments for eosinophilic pustular folliculitis in 20 patients.[19] Oral cyclosporine was markedly effective in all 11 patients treated with the drug, and topical tacrolimus ointment alleviated eosinophilic pustular folliculitis in 3 of 7 of the study participants. In addition to indomethacin or other oral nonsteroidal anti-inflammatory drugs (NSAIDs), oral cyclosporine and topical tacrolimus appeared to be beneficial in patients resistant to previous treatments. Others also recommend cyclosporine.[20]

Retinoids, such as isotretinoin, inhibit sebaceous gland function and keratinization. Clinical improvement occurs in association with a reduction in sebum secretion. This effect is temporary and is related to the dose and duration of treatment. Monitoring for hypertriglyceridemia and hepatotoxicity is required. Common adverse effects include cheilitis and alopecia. Systemic retinoid therapy is teratogenic; it is indicated only in patients who have no reproductive potential. Alternatives include indomethacin and dapsone.

In patients infected with HIV, treat mild eosinophilic folliculitis with topical steroids and oral antihistaminics. Treat moderate disease with oral itraconazole, isotretinoin, or phototherapy. Treat severe eosinophilic folliculitis with isotretinoin therapy for several months.

Potential treatments include oxyphenbutazone, colchicine, minocycline, acitretin, cyclosporine A, UV-B therapy,[21, 22] interferon alfa-2b, tacrolimus,[23, 24, 25] doxycycline,[26] and radiation therapy.[27]

Next

Consultations

Consider referral to a dermatologist in the following settings:

  • If the diagnosis of eosinophilic folliculitis needs to be confirmed
  • If the response to treatment is inadequate
  • If the primary care physician is not familiar with the recommended treatment modality
  • If the patient has widespread or severe eosinophilic folliculitis
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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, The Pritzker School of Medicine

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.

Specialty Editor Board

Joseph Richard Masci, MD  Professor of Medicine, Professor of Preventive Medicine, Mount Sinai School of Medicine; Director of Medicine, Elmhurst Hospital Center

Joseph Richard Masci, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, Association of Professors of Medicine, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Joseph F John Jr, MD, FACP, FIDSA, FSHEA  Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

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.

References

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Eosinophilic pustular folliculitis in a patient infected with HIV. Note acneiform hyperpigmented papules. Photograph courtesy of Sarah A. Myers, MD.
Eosinophilic pustular folliculitis in a patient who is HIV-positive. Note follicular-based excoriated papules and pustules on the trunk. Photograph courtesy of Sarah A. Myers, MD.
Eosinophilic folliculitis (low-power). Note eosinophilic spongiosis, particularly involving the infundibular region of the hair follicle.
Eosinophilic folliculitis (high-power). In addition to the abundant eosinophils, note the variable numbers of neutrophils and mononuclear cells.
 
 
 
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