Eosinophilic pustular folliculitis


A rare skin disorder characterized by the recurring development of characteristic skin papules and pustules.


* Itching * Circinate plaques * Serpiniginous plaques * Pustules * Small skin bumps


The most common cause of folliculitis, furunculosis, or carbunculosis is coagulase-positive Staphylococcus aureus. Predisposing factors include an infected wound, poor hygiene, debilitation, diabetes, alcoholism, occlusive cosmetics, tight clothes, friction, chafing, exposure to chemicals, and treatment for skin lesions with tar or with occlusive therapy, using steroids. Furunculosis often follows folliculitis exacerbated by irritation, pressure, friction, or perspiration. Carbunculosis follows persistent S. aureus infection and furunculosis.


Eosinophilic folliculitis may be suspected clinically when an individual with HIV exhibits the classic symptoms. The diagnosis can be supported by the finding of eosinophilia but a skin biopsy is necessary to establish it. Skin biopsies reveal lymphocytic and eosinophilic inflammation around the hair follicles.


Treatment of eosinophilic folliculitis in people with HIV typically begins with the initiation of Highly Active Anti-Retroviral Therapy in order to help reconstitute the immune system. Direct treatment of the EF itself focuses on decreasing the inflammation and itching. Topical corticosteroids and oral antihistamines can alleviate the itching and decrease the size and number of lesions. Treatment with the antifungal drug itraconazole, the antibiotic metronidazole, and the anti-mite drug permethrin may lead to some improvement of symptoms. Other therapies include PUVA, topical tacrolimus, and isotretinoin