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HIV-associated eosinophilic folliculitis appearing in a patient with end-stage AIDS
Abstract
HIV-associated eosinophilic folliculitis is characterized by recurrent crops of severely-pruritic follicular papules, pustules and plaques that occur mainly on the face, trunk and upper extremities of AIDS patients. This disease is distinguished from Ofuji's disease by severe pruritus, leukopenia, sparing of the palm and sole and a good response to phototherapy. Up to now, only three such cases have been reported in the Korean literature. A 55-year-old man, who was confirmed as being HIV positive 6 months previously, presented with severely-pruritic, erythematous pinhead to half pea sized papules and nodules on the face, neck and anterior chest. The skin biopsy from a nodular lesion on the face revealed perifolliculitis with a predominant eosinophilic infiltrate.
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Eosinophilic pustular folliculitis(EPF) may be classified into 3 clinical types; classic(Ofuji's disease), HIV-associated, and infantile form. Compared with classical type, HIV-associated eosinophilic folliculitis(HIV-associated EF) reveals the distinctive features, such as scattered erythematous urticarial papules on the trunk, head, neck, and proximal aspect of the extremities. We herein report a case of HIV-associated EF occuring in a 48-year-old man who had severe pruritic, multiple, crythematous, follicular and non follicular papules and nodules on the scalp, face, neck, and anterior chest. Biopsy specimen revealed folliculitis with a predominant eosinophilic infiltrate. To our knowledge, this is the second case of HIV-associated EF in Korea.
HIV-associated eosinophilic folliculitis is characterized by recurrent crops of severely-pruritic follicular papules, pustules and plaques that occur mainly on the face, trunk and upper extremities of AIDS patients. This disease is distinguished from Ofuji's disease by severe pruritus, leukopenia, sparing of palms and soles, and a good response to phototherapy. Up to now, two cases were reported in the Korean literature. A 38-year-old man, who was confirmed as HIV positive 11 years ago, presented with severely-pruritic, erythematous pinhead to half pea sized papules and pustules on the face, neck, and anterior chest. The skin biopsy from a papular lesion on the upper chest revealed folliculitis and perifolliculitis with a predominant eosinophilic infiltrate.
Eosinophilic pustular folliculitis is characterized by the spontaneous development of recurrent, sterile papules, pustules, and plaques on the face, trunk, arms, and occasionally the palms and soles. Although the large majority of the reported cases have occurred in Eastern Asians, most patients in the United States have been infants or men seropositive for human immunodeficiency virus. We describe a North American woman with eosinophilic pustular folliculitis who was neither seropositive for human immunodeficiency virus nor of Asiatic descent.
Eosinophilic folliculitis (EF) is a chronic, intensely pruritic condition of unknown pathogenesis that causes marked morbidity in those HIV patients whom it affects. There is a wide differential diagnosis of itchy skin conditions in HIV which are amenable to different treatments. It is therefore essential to take a biopsy of each suspected case and examine multiple sections of the biopsy to confirm or refute a diagnosis of EF. Treatment of EF can be difficult but we hope that by suggesting a rational approach to this and considering possible therapeutic options more patients may be helped with this troublesome dermatosis.
Ultraviolet B phototherapy, which has not been used previously to treat eosinophilic pustular folliculitis, has had a substantial success rate at our institution in the treatment of the disorder in patients with AIDS. So far, our experience suggests that longer courses of phototherapy may lead to resolution of the lesions. The lesions generally recur when phototherapy is discontinued, suggesting that maintenance therapy is required.
Eosinophilic pustular folliculitis is a rare disease. Highly unusual is its occurrence in three patients with acquired immunodeficiency syndrome (AIDS), described herein. This association may be the result of immunologic aberrations that are described in AIDS and may represent an abnormal reaction to skin saprophytes and dermatophytes.