Eosinophilic pustular folliculitis

Ofuji 1970.

Eosinophilic pustulosis, eosinophilic pustular folliculitis, Ofuji syndrome, eosinophilic folliculitis. Do not confuse with papuloerythroderma Ofuji 1984 ("deckchair sign").

Non-infectious, relapsing folliculitis.

• Division
  • Infantile form.
  • Classical form.
  • Immune suppression-associated form.

• Rare, rather occurring in the Asian region (Japan)
• Infantile form: Boys are more often affected than girls. The frequency peak is between 5-10 months. Here often preceding infestations such as scabies, larva migrans.
• Classical form: Young men (3rd-5th decade of life).
• Rarely occurring in neonates. Sporadic neonatal cases exist.
• Adult form: In this case, young males (3rd-4th decade of life) are most affected

• In the immunosuppression-associated form: mostly HIV infections, from < 200 CD4 T cells.
• Drug-induced: carbamazepine, allopurinol.

Pruritic, erythematous papules, plaques and sterile pustules, some of which are confluent. Usually pustules are less visible. Regression is often visible centrally. Healing occurs with postinflammatory hyperpigmentation.

Localisation:

• In particular, the face (in women in 93%, in men 73% facial involvement).
• Classical form: face (about 90% of cases), trunk (1/3), extremities (1/4), hands/feet (1/5), scalp (1/10).
• Infantile form: face (approx. 2/3 of cases), trunk (2/3), extremities (1/10), hands/feet (0), scalp (1/5).
• Immunosuppression-associated form: face (approx. 25% of cases), trunk (0), extremities (25%), hands/feet (0), scalp (50%).

• Anamnesis
• Clinical picture
• Blood count, in 1/3 of cases eosinophilia
• Biopsy
• HIV serology
• IgE level

Mostly face, torso, extremities

Superficial spongiotic, eosinophil-rich dermatitis with folliculitis

Chronic-recurrent course

• Spontaneous healing is possible
• Healing under hyperpigmentation
• Seldom also under scarring.

Topical therapy

• Zinc-containing externals (Lotio alba)
• Dermocorticoids: Class III (potent): mometasone fuorate cream
• Calcineurin inhibitors: tacrolimus ointment 0.1% 2x daily for 2 weeks
• Permethrin 5% cream (against Demodex mites, which can act as a trigger).

Radiation therapy: PUVA / UVB

Systemic therapy

• Antihistamines (H1 blockers, desloratadine (p.o. 5 mg 1x daily) NW: fatigue. CI: pregnancy, lactation, hypersensitivity to ingredient.
• NSAID (indomethacin) p.o. 1-2x daily 75mg
• Folic acid antagonists
• Sulphones (dapsone) p.o. 1.5mg/kg bw daily, if necessary increase every 2 weeks by 25-50mg, up to max. 300mg daily. Before administration: exclusion of glucose-6-phosphate dehydrogenase deficiency. Met-Hb: should be checked 2 weeks and 6 weeks after starting therapy.
• Systemic glucocorticoids: prednisolone p.o. 0.5-1.0 mg/kg/d, in tapering application frequency, methylprednisolone p.o. 40mg 1x daily.

1. Ofuji S. Eosinophilic Pustular Folliculitis. Dermatology 1987;174:53-6.
2. Ota T, Hata Y, Tanikawa A, Amagai M, Tanaka M, Nishikawa T. Eosinophilic pustular folliculitis (Ofuji's disease): indometacin as a first choice of treatment. Clinical and Experimental Dermatology 2001;26:179-81.
3. Katoh M, Nomura T, Miyachi Y, Kabashima K. Eosinophilic pustular folliculitis: a review of the Japanese published works. J Dermatol 2013;40:15-20.