Eosinophilic Folliculitis Workup

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

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.
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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. Basophils in cutaneous infiltrates of this disorder have been noted.[16] See the images below.

Eosinophilic folliculitis (low-power). Note eosinoEosinophilic folliculitis (low-power). Note eosinophilic spongiosis, particularly involving the infundibular region of the hair follicle. Eosinophilic folliculitis (high-power). In additioEosinophilic folliculitis (high-power). In addition to the abundant eosinophils, note the variable numbers of neutrophils and mononuclear cells.
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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.

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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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