Eosinophilic pustular folliculitis
Last Updated: 2022-03-25
Eosinophilic pustulosis, eosinophilic pustular folliculitis, Ofuji syndrome, eosinophilic folliculitis. Do not confuse with papuloerythroderma Ofuji 1984 ("deckchair sign").
Non-infectious, relapsing folliculitis.
- 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.
- 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%).
- Clinical picture
- Blood count, in 1/3 of cases eosinophilia
- HIV serology
- IgE level
Mostly face, torso, extremities
Superficial spongiotic, eosinophil-rich dermatitis with folliculitis
- Spontaneous healing is possible
- Healing under hyperpigmentation
- Seldom also under scarring.
- 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
- 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.
- Ofuji S. Eosinophilic Pustular Folliculitis. Dermatology 1987;174:53-6.
- 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.
- Katoh M, Nomura T, Miyachi Y, Kabashima K. Eosinophilic pustular folliculitis: a review of the Japanese published works. J Dermatol 2013;40:15-20.