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

A biopsy specimen is often necessary.^[38] Obtaining 2 punch biopsy specimens, to allow for both vertical and transverse sectioning, has been proposed to increase the sensitivity of finding the characteristic features of eosinophilic folliculitis.^[39]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. HIV-associated eosinophilic folliculitis has a more intense perivascular and diffuse inflammatory infiltration compared with that of the HIV-related pruritic papular eruption.^[40]

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.^[41]

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

View Media Gallery

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

View Media Gallery

Treatment & Management

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Media Gallery

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.

of 4

Author

Camila K Janniger, MD Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, Rutgers 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)

M Angelica Selim, MD, MD Director of Dermatopathology, Departments of Pathology and Internal Medicine, Associate Professor, Duke University Medical Center

Disclosure: Nothing to disclose.

Christopher R Shea, MD Eugene J Van Scott Professor in Dermatology, 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, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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

Joseph F John, Jr, MD, FACP, FIDSA, FSHEA is a member of the following medical societies: Charleston County Medical Association, Infectious Diseases Society of America, South Carolina Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Rajendra Kapila, MD, MBBS † Professor, Department of Medicine, Rutgers 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, Infectious Diseases Society of New Jersey

Disclosure: Nothing to disclose.

Harry Dao, Jr, MD Assistant Professor, Department of Dermatology, Baylor College of Medicine

Harry Dao, Jr, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Sections Eosinophilic Folliculitis
Overview
Presentation
- History
- Physical
- Causes
- Complications
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DDx
Workup
Treatment
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Eosinophilic Folliculitis Workup

Laboratory Studies

Histologic Findings

References

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