HIV-associated eosinophilic folliculitis
- Priya Rajendran, MD
Priya Rajendran, MD
- Clinical Instructor
- University of California, San Francisco
- Whitney A High, MD
Whitney A High, MD
- Associate Professor of Dermatology and Dermatopathology
- University of Colorado School of Medicine
- Toby Maurer, MD
Toby Maurer, MD
- Professor of Dermatology
- University of California, San Francisco, School of Medicine
Eosinophilic folliculitis (EF) is a pruritic skin eruption consisting of follicular papules or pustules, predominantly located on the scalp, face, neck, and upper chest (picture 1A-B).
EF is a relatively common skin eruption in patients with advanced human immunodeficiency virus (HIV) disease [1,2]. A clinically distinct form of EF (Ofuji's disease) has also been described in otherwise healthy individuals, particularly in Japan . Other rare types of non-HIV-associated EF include infantile EF and EF associated with bone marrow transplantation [4,5]. Non-HIV-associated EF has also been described as a rare side effect of medication, including chemotherapy .
This topic reviews the presentation and management of HIV-associated EF. Bacterial folliculitis is discussed separately. (See "Infectious folliculitis".)
HIV-associated EF most commonly occurs in patients with late-stage disease or low CD4 counts . EF has been reported in HIV-infected men, women, and children [7-9]. The prevalence is uncertain, although one series of HIV patients reported folliculitis in 9 percent . In our experience, since the advent of antiretroviral therapy, EF has become less common.
The etiology of EF is unknown. Clinical characteristics of EF suggest that it may be an inflammatory disease related to immune dysregulation, perhaps in association with an underlying infection [11,12].
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- RISK FACTORS
- CLINICAL MANIFESTATIONS
- DIFFERENTIAL DIAGNOSIS
- First-line therapy
- - Antiretroviral therapy
- - Topical corticosteroids
- - Antihistamines
- Second-line therapy
- - Phototherapy
- Third-line therapies
- - Itraconazole
- - Oral isotretinoin
- Other therapies
- - Topical permethrin
- - Topical calcineurin inhibitors
- - Oral metronidazole
- - Oral dapsone
- - Oral glucocorticoids
- - Other
- SUMMARY AND RECOMMENDATIONS