Eosinophilic Pustular Folliculitis

Introduction

Eosinophilic pustular folliculitis, also called eosinophilic folliculitis or Ofuji disease, is a recurrent skin condition characterized by itchy, red-colored bumps or pustules. Its cause is unknown. Skin biopsies of this condition find eosinophil’s immune cells around the hair follicle, which gives it the name eosinophilic pustular folliculitis. The pustules or bumps usually occur in the face, neck, scalp, and trunk and may last for weeks or months.

What Is Eosinophilic Pustular Folliculitis?

Folliculitis is a collection of cells and connective tissue around the hair that gets inflamed. Folliculitis can manifest in any part of the body where hair follicles are present, except for areas without hair growth, like the palms of the hands and soles of the feet. Eosinophils are cells of the immune system that help to fight against infection. Eosinophilic folliculitis is a condition where the eosinophilic cells around the hair follicles cause inflammation.

What Are the Variants of Eosinophilic Pustular Follicles?

Eosinophilic pustular folliculitis is a rare condition of many types, and the presence of pustules and bumps characterizes all. Various types include:

• Classic-type eosinophilic pustular folliculitis is seen in the population of Japan.

• Eosinophilic pustular folliculitis is associated with infection caused by HIV (human immunodeficiency virus).

• Infantile eosinophilic pustular folliculitis occurs in children from birth to the initial year of life.

• Cancer-related eosinophilic pustular folliculitis may occur due to chemotherapy.

• Medication-related eosinophilic pustular folliculitis.

What Does Eosinophilic Pustular Folliculitis Look Like?

Eosinophilic pustular folliculitis characteristic feature is the presence of pustules or bumps that usually occur in the neck, scalp, face, etc. These pustules are itchy red or skin-colored dome-shaped, which may resemble acne or other types of folliculitis. Very rarely, urticarial lesions, which are large red irritable patches, can be seen. Folliculitis does not occur in the palm and sole, but it is not called folliculitis if it does occur. Due to constant itching, these folliculitis may develop into dermatitis or prurigo.

How Do the Signs and Symptoms of Eosinophilic Pustular Folliculitis Manifest?

The symptoms of eosinophilic pustular folliculitis are similar to those of other folliculitis. Some affected people may not display signs and symptoms, while others will have itchy and painful skin. Some common symptoms are:

• Pustular in this form of folliculitis will contain pus in the hair follicle.

• Inflamed irritated or red skin around the hair follicle.

• Inflammation results in damaged hair.

What Are the Causes of Eosinophilic Pustular Folliculitis?

Folliculitis occurs due to the inflammation of the hair follicle, which is caused due to infection, injury, chemotherapy, medication, or irritation. The American Academy of Dermatology posts various causes, these are:

• Taking baths in hot tubs.

• Removal of hair through shaving, waxing, or plucking.

• Using tight clothes.

• Increased weight.

• Topical application of medications such as coal tar.

• Hot and damp skin is more prone to infection.

In this particular condition, eosinophilic inflammation occurs around the hair follicles, although the exact cause of eosinophil accumulation remains unclear.

What Is the Cause of Eosinophilic Pustular Folliculitis of HIV?

The cause of HIV-related eosinophilic pustular folliculitis is not known. HIV infection usually attacks the immune system and reduces the number of CD4 cells, a type of immune cell. People affected with HIV have a compromised immune system and are more prone to infections and certain types of allergic-type skin diseases. It is not clear whether bacterial, viral, or fungal diseases cause the condition. Some studies have shown that certain hair follicle mites may cause the condition. Some other studies suggest that changes in the immune system due to HIV would cause immune cells to attack cells in sebaceous glands. However, there is no clear evidence of why folliculitis is related to HIV infection.

How Is Eosinophilic Pustular Folliculitis Diagnosed?

A dermatologist performs a physical examination, which helps diagnose the condition. Patches or red, inflamed skin with pimples, bumps, or pustules are seen during physical examination. The personal history of the affected person is checked. A biopsy is conducted to confirm the diagnosis of this condition. During the procedure, a small skin sample is extracted and examined under a microscope. The biopsy result reveals the presence of eosinophils beneath the skin, around hair follicles, and the sebaceous gland. In most affected cases, there is a rise in the eosinophilic cells and immunoglobulin E (IgE), which can be ruled out through blood tests. In these cases, there are reduced immunoglobulin G (IgG) and immunoglobulin A (IgA) levels.

Immunodeficiency usually results in eosinophilic pustular folliculitis. This condition occurs due to infection caused by HIV when the CD4 cell count reduces. During this stage, there is a significant risk of developing secondary infections. Eosinophilic pustular folliculitis can also occur following a bone marrow transplant, prior to the restoration of normal immune system function.

Treatment for Eosinophilic Pustular Folliculitis:

The management strategy for eosinophilic pustular folliculitis generally varies depending on the seriousness of symptoms and the presence of any coexisting underlying conditions. In very mild cases, the condition can be treated with the help of home remedies. One of the common remedies is that individuals can apply a warm compress for 15 minutes. It can be repeated three to four times a day. To mitigate the risk of infection, it is advisable to refrain from hair removal methods such as plucking, waxing, or shaving.

HIV infection is associated with eosinophilic pustular folliculitis, where antiretroviral therapy is recommended for those affected. This treatment helps to improve the HIV condition as well as the symptoms caused by eosinophilic pustular folliculitis. Other treatments which can be helpful are:

• NSAIDs (non-steroidal anti-inflammatory drugs) are seen to be effective in 70 percent of the affected population.

• Use of antibiotics if there is no HIV infection.

• Phototherapy, in this bright light, is exposed, which helps to treat many medical conditions.

• Topical steroids.

• Antihistamines.

• Topical insecticide.

• Nicotine patches.

Conclusion

Eosinophilic pustular folliculitis is a rare skin condition that occurs in the skin, scalp, or face without apparent cause. Red, itchy patches, bumps, or pimples characterize this condition. In the case of eosinophilic pustular folliculitis, there is inflammation of eosinophils that accumulate around the hair follicle. This condition is often associated with people affected by HIV infection. Depending on the severity of the disease, treatment can be provided through medications.