Eosinophilic Pustular Folliculitis Treatment & Management

Updated: Apr 05, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

A variety of options have been described with variable results.

In classic cases, common options for treatment include indomethacin (orally or topically) [32, 33] and its newer derivative acemetacin, [34] dapsone, topical and systemic steroids, isotretinoin, itraconazole, permethrin, interferon, and antibiotics. [35] The experience of Japanese dermatologists is that indomethacin is by far the most effective in the classic form, although the mode of its action in this disease is still poorly understood. [36] A multivariable analysis showed that females were more likely than males to exhibit a complete response to oral indomethacin. [37] Naproxen has also been used with some success. [38]

Narrowband UVB phototherapy may be effective. [39] Ultraviolet therapy with ultraviolet B or with ultraviolet A and psoralen plus ultraviolet A may be beneficial. [40, 41]

One may use topical itraconazole cream first in patients with HIV-associated disease, adding an oral sedating antihistamine for bedtime use if pruritus is severe. Cetirizine seems to be a favorite because of its preferential effect on eosinophils, [42] with some preferring 4 mg of cyproheptadine at bedtime.

In patients with HIV-associated disease, antiretroviral therapy tends to greatly diminish or even eliminate the severity of this disorder.

Some patients with HIV-associated Ofuji disease may respond to oral metronidazole.