Eosinophilic Folliculitis Medication

Updated: Mar 17, 2021
  • Author: Camila K Janniger, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

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Corticosteroids

Class Summary

These agents have both anti-inflammatory (glucocorticoid) and salt-retaining (mineralocorticoid) properties. Glucocorticoids have profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.

Prednisone

May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

Prednisolone (Millipred, Orapred, Orapred ODT, Prelone)

Corticosteroids act as potent inhibitors of inflammation. They may cause profound and varied metabolic effects, particularly in relation to salt, water, and glucose tolerance, in addition to their modification of the immune response of the body. Alternative corticosteroids may be used in equivalent dosage.

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Retinoid-like Agents

Class Summary

These agents decrease cohesiveness of abnormal hyperproliferative keratinocytes and may reduce potential for malignant degeneration. They modulate keratinocyte differentiation. They also reduce the risk of skin cancer in patients who have undergone renal transplant.

Isotretinoin (Amnesteem, Claravis, Sotret)

Retinoid acid derivative reduces size of sebaceous gland and decreases sebum production. Also regulates cell differentiation and proliferation.

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Nonsteroidal anti-inflammatory agents (NSAIDs)

Class Summary

These agents have analgesic, anti-inflammatory, and antipyretic activities. The mechanism of action is not known but may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may also exist (eg, inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, various cell-membrane functions).

Indomethacin (Indocin)

Rapidly absorbed; metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation; inhibits prostaglandin synthesis.

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Antibiotics, Other

Class Summary

These agents may improve the clinical stage of the disease.

Dapsone

Bactericidal and bacteriostatic against mycobacteria; mechanism of action is similar to that of sulfonamides in which competitive antagonists of PABA prevent formation of folic acid, thus inhibiting bacterial growth.

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Immunosuppressants

Class Summary

Treatment with oral cyclosporine might successfully control eosinophilic pustular folliculitis refractory to indomethacin. Oral cyclosporine has been shown to be markedly effective in patients treated with the drug, and topical tacrolimus ointment alleviated eosinophilic pustular folliculitis. Oral cyclosporine and topical tacrolimus may be beneficial in patients resistant to previous treatments. Others also recommend cyclosporine.

Topical tacrolimus is a good option for both eosinophilic pustulosis of infancy and adult cases. Topical tacrolimus ointment 0.03% may produce rapid clearance in infants.

A 13-year old girl with eosinophilic pustular folliculitis was treated with benralizumab, an antibody medication directed against the alpha-chain of the interleukin-5 receptor. [62]

Cyclosporine (Gengraf, Neoral, Sandimmune)

Cyclosporine is a cyclic polypeptide that suppresses some humoral immunity and, to a greater extent, cell-mediated immune reactions. Suppresses mRNA expression of Th2 cytokines (interleukins 4 and 13) in peripheral blood mononuclear cells.

Pimecrolimus cream (Elidel)

Pimecrolimus cream is used for short-term treatment or for intermittent, long-term treatment in unresponsive or intolerant cases. It is available in a 1% cream.

This was the first nonsteroid cream approved in the United States for mild to moderate atopic dermatitis. It is derived from ascomycin, a natural substance produced by the fungus Streptomyces hygroscopicus var. ascomyceticus. Pimecrolimus cream selectively inhibits the production and release of inflammatory cytokines from activated T cells by binding to cytosolic immunophilin receptor macrophilin-12. The resulting complex inhibits phosphatase calcineurin, thus blocking T-cell activation and cytokine release. Cutaneous atrophy was not observed in clinical trials, a potential advantage over topical corticosteroids. Pimecrolimus cream is indicated only after other treatment options have failed.

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