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Abstract
Patients living with HIV may experience a variety of inflammatory dermatoses, ranging from exacerbations of underlying conditions to those triggered by HIV infection itself. This article presents a current literature review on the etiology, diagnosis and management of atopic dermatitis, psoriasis, pityriasis rubra pilaris, lichen planus, seborrheic dermatitis, eosinophilic folliculitis, pruritic papular eruption and pruritus, in patients living with HIV.
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Affiliation(s)
- Robert Bobotsis
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Shakira Brathwaite
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Panteha Eshtiaghi
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Fabian Rodriguez-Bolanos
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Philip Doiron
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada.
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Knight CL. Physical Examination in Human Immunodeficiency Virus Disease. Med Clin North Am 2022; 106:527-536. [PMID: 35491072 DOI: 10.1016/j.mcna.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Human immunodeficiency virus (HIV)-associated disease is known for its protean manifestations. However, many of the characteristic findings on physical examination are not associated with HIV infection per se but the numerous opportunistic infections (OIs) that are common in patients with advanced HIV disease. Common findings of acute HIV infection include fever, adenopathy, rash, and oral ulcers. Chronic HIV infection is associated with skin, rheumatologic, and neurologic manifestations. OIs also cause skin, oropharyngeal, ocular, and neurologic manifestations. A skilled clinician can often recognize HIV disease based on the combination of these findings.
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Immune recovery folliculitis: Case reports in HIV naïve and experienced patients. IDCases 2021; 26:e01324. [PMID: 34777994 PMCID: PMC8577432 DOI: 10.1016/j.idcr.2021.e01324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 12/01/2022] Open
Abstract
Immune recovery folliculitis (IRF) is defined as the development of an inflammatory disorder of the facial pilo-sebaceous unit due to the immune reconstitution inflammatory syndrome (IRIS). Skin lesions can be related to an immune response against skin saprophyte bacteria (e.g. Demodex folliculorum, Cutibacterium acnes). The rapid reconstitution of T lymphocyte, with a CD8+ predominance, is considered a key pathogenic factor for this phenomenon. IRF is clinically similar to acne vulgaris and can be challenging to treat. Patients with facial pustules can experience social discomfort. Here we report two cases of IRF diagnosed at the human immunodeficiency virus (HIV) clinic of the National Institute of Infectious Diseases L. Spallanzani, in Rome, Italy. The first case occurred in an antiretroviral therapy (ART)-experienced patient, after a treatment simplification; the second one was registered in an ART-naïve patient, diagnosed with acute HIV infection shortly, after ART initiation. To date, an IRF secondary to an ART switch, has not been described yet. IRF should be ruled out and considered in differential diagnosis from antiretroviral drug-related skin effects.
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Key Words
- ART, Antiretroviral Therapy
- BIC/F/TAF, Bictegravir/Emtricitabina/Tenofovir alafenamide fumarate
- CDC, Centers for Disease Control
- Case report
- DRV/c, Darunavir/cobicistat
- E/C/F/TAF, Elvitegravir/cobicistat/Emtricitabina/Tenofovir alafenamide fumarate
- HIV infection
- HIV, Human Immunodeficiency Virus
- IRF, Immune Recovery Folliculitis
- IRIS, Immune Reconstitution Inflammatory Syndrome
- Immune reconstitution inflammatory syndrome
- Immune recovery folliculitis
- LPV/r, Lopinavir/ritonavir
- RAL, Raltegravir
- TAF/FTC, Tenofovir alafenamide fumarate/Emtricitabina
- TDF/FTC, Tenofovir disoproxil fumarate/Emtricitabine
- Therapy simplification
- VL, Viral Load
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Chuh A. Eosinophilic folliculitis due to wearing protective gear in citizens volunteering for sanitation services during the COVID-19 pandemic - an original epidemiological, clinical, dermoscopic, and laboratory-based study. Int J Dermatol 2020; 59:1468-1474. [PMID: 33040344 PMCID: PMC7675530 DOI: 10.1111/ijd.15227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND An association between wearing protective gear and eosinophilic folliculitis has not been reported. We aimed to investigate such during the COVID-19 pandemic. METHODS In three outpatient clinics, we hand-reviewed records of all patients having consulted us during a Study Period (90 days) in the early phase of the pandemic. Our inclusion criteria for Study Subjects were: (i) clear clinical diagnosis, (ii) dermoscopic confirmation, (iii) differential diagnoses excluded, (iv) eosinophilia, (v) protective gear worn during sanitation services, (vi) temporal correlation, (vii) distributional correlation, (viii) physician-assessed association, and (ix) patient-assessed association. Control Periods in the same season were elected. RESULTS Twenty-five study subjects fulfilled all inclusion criteria. The incidence was significantly higher than in the control periods (IR: 3.57, 95% CI: 1.79-7.43). Male predominance was significant (P < 0.001). Such for patients in the control periods were insignificant. Study subjects were 21.2 (95% CI: 11.0-31.4) years younger than patients in the control periods. For the study subjects, the distribution of erythematous or skin-colored folliculocentric dome-shaped papules and pustules were all compatible with body parts covered by the gear. Lesional biopsy performed on two patients revealed eosinophilic dermal infiltrates within and around the pilosebaceous units. Polarized dermoscopy revealed folliculitis with peri-/interfollicular vascular proliferation. Lesion onsets were 6.4 (SD: 2.1) days after wearing gear. Remissions were 16.7 (SD: 7.5) days after ceasing to wear gear and treatments. CONCLUSIONS Wearing protective gear in volunteered sanitizing works could be associated with eosinophilic folliculitis. Owing to the significant temporal and distributional correlations, the association might be causal.
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Affiliation(s)
- Antonio Chuh
- Department of Family Medicine and Primary Care, The University of Hong Kong and Queen Mary Hospital, Pokfulam, Hong Kong.,Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong
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Pomerantz H, Wang H, Heilman ER, Sharon VR, Gottesman SP. Peculiar vegetative tumor-like genital herpes simplex nodules with brisk tissue eosinophilia in patients with human immunodeficiency virus infection. J Cutan Pathol 2019; 47:150-153. [PMID: 31437312 DOI: 10.1111/cup.13568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022]
Abstract
Genital herpes simplex virus (HSV) infection in a human immunodeficiency virus (HIV) patient can present as a vegetative nodule. Clinical differential diagnoses of the nodule include condyloma latum, condyloma acuminatum, viral or fungal infection, and cutaneous neoplasms. Histological examination of herpetic nodules has been reported to show thick pseudoepitheliomatous hyperplasia with dense dermal lymphoplasmacytic infiltrate and multifocal multinucleated cells with herpetic viral cytopathic changes. We report two patients with HIV presenting with vegetative tumor-like HSV nodules with distinctive histopathologic pattern of inflammation that has not been described in the literature before. All samples displayed slightly acanthotic epidermis with focal ulceration, dense dermal sclerosis, scattered plasma cells, and a brisk lymphoeosinophilic infiltrate found dissecting between dense collagen bundles. This pattern of inflammation is an important clue that can guide the pathologist to look for focal herpetic viral changes in the epidermis, as patients with HIV possibly tend to amount a predominantly eosinophilic immune response in inflammatory skin conditions.
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Affiliation(s)
- Hyemin Pomerantz
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Hongbei Wang
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Edward R Heilman
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York
| | - Victoria R Sharon
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Silvija P Gottesman
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
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Ogawa K, Mitsui Y, Miyamoto S, Nakamura-Nishimura Y, Nakanishi Y, Azukizawa H, Asada H. Facial pustules due to drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms may histopathologically mimic eosinophilic pustular folliculitis: A case report. J Cutan Pathol 2019; 46:363-367. [PMID: 30666704 DOI: 10.1111/cup.13428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 11/29/2022]
Abstract
Pustules with facial and/or neck edema is one characteristic feature of drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS) at the early stage. Although several retrospective histopathologic studies on DIHS/DRESS have been reported, the detailed histopathologic findings of facial pustules for DIHS/DRESS are unavailable. We herein report a case of DIHS/DRESS with facial pustules that was histopathologically similar to eosinophilic pustular folliculitis (EPF). Eosinophilic infiltration into expanded follicles and sebaceous glands, which is highly characteristic of EPF, was detected in pustules due to DIHS/DRESS in this case. There are numerous pathophysiological similarities between DIHS/DRESS and EPF, which may cause their histopathologic similarity. Our findings suggest that facial pustules of DIHS/DRESS may histopathologically mimic EPF.
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Affiliation(s)
- Kohei Ogawa
- Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan
| | - Yasuhiro Mitsui
- Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan
| | - Suzuka Miyamoto
- Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan
| | | | - Yukiko Nakanishi
- Department of Dermatology, Nara Prefecture General Medical Center, Nara, Japan
| | - Hiroaki Azukizawa
- Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan
| | - Hideo Asada
- Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan
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Curtis C, Ogbogu PU. Evaluation and Differential Diagnosis of Persistent Marked Eosinophilia. Immunol Allergy Clin North Am 2015. [PMID: 26209891 DOI: 10.1016/j.iac.2015.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Peripheral blood eosinophilia is commonly encountered in clinical practice. The causes of peripheral blood eosinophilia are varied, ranging from benign eosinophilia to malignancy. A careful history and physical examination along with directed clinical evaluation may help determine the cause. When uncontrolled, peripheral blood eosinophilia may result in end-organ damage and life-threatening complications. This article summarizes the differential diagnosis and evaluation of persistent marked eosinophilia.
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Affiliation(s)
- Casey Curtis
- Section of Allergy & Immunology, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Wexner Medical Center at the Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA.
| | - Princess U Ogbogu
- Section of Allergy & Immunology, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Wexner Medical Center at the Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA
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Lee W, Won K, Won C, Chang S, Choi J, Moon K, Lee M. Facial and extrafacial eosinophilic pustular folliculitis: a clinical and histopathological comparative study. Br J Dermatol 2014; 170:1173-6. [DOI: 10.1111/bjd.12755] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2013] [Indexed: 11/27/2022]
Affiliation(s)
- W.J. Lee
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; 388-1 Pungnapdong Songpagu Seoul 138-736 Korea
| | - K.H. Won
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; 388-1 Pungnapdong Songpagu Seoul 138-736 Korea
| | - C.H. Won
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; 388-1 Pungnapdong Songpagu Seoul 138-736 Korea
| | - S.E. Chang
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; 388-1 Pungnapdong Songpagu Seoul 138-736 Korea
| | - J.H. Choi
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; 388-1 Pungnapdong Songpagu Seoul 138-736 Korea
| | - K.C. Moon
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; 388-1 Pungnapdong Songpagu Seoul 138-736 Korea
| | - M.W. Lee
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; 388-1 Pungnapdong Songpagu Seoul 138-736 Korea
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Abstract
Follicular disorders are possibly a commonly seen, though rarely reported, group of disorders, which are localized around follicles and appendages and clinically present as small papules. Classically, clinicopathological follicular plugging is seen in the "true" follicular disorders, which are appropriately referred to as follicular keratosis. Another subtype is folliculitis (infectious or noninfectious) and the follicular mimickers that clinically resemble "true" follicular disorders without the follicular keratoses. Acne vulgaris has an amalgamation of all the above lesion types. Our review is aimed at describing all the follicular disorders and gives an algorithm for diagnosing the common follicular disorders.
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Epidemiological characteristics of Malassezia folliculitis and use of the May-Grünwald-Giemsa stain to diagnose the infection. Diagn Microbiol Infect Dis 2013; 76:450-7. [DOI: 10.1016/j.diagmicrobio.2013.04.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 03/27/2013] [Accepted: 04/02/2013] [Indexed: 11/22/2022]
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Afonso JPJM, Tomimori J, Michalany NS, Nonogaki S, Porro AM. Pruritic papular eruption and eosinophilic folliculitis associated with human immunodeficiency virus (HIV) infection: A histopathological and immunohistochemical comparative study. J Am Acad Dermatol 2012; 67:269-75. [DOI: 10.1016/j.jaad.2011.11.923] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 10/28/2011] [Accepted: 11/10/2011] [Indexed: 11/30/2022]
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Razera F, Olm GS, Bonamigo RR. Dermatoses neutrofílicas: parte II. An Bras Dermatol 2011; 86:195-209; quiz 210-1. [DOI: 10.1590/s0365-05962011000200001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Indexed: 11/22/2022] Open
Abstract
Neste artigo são abordadas as dermatoses neutrofílicas, complementando o artigo anterior (parte I). São apresentadas e comentadas as seguintes dermatoses: pustulose subcórnea de Sneddon-Wilkinson, dermatite crural pustulosa e atrófica, pustulose exantemática generalizada aguda, acroder matite contínua de Hallopeau, pustulose palmoplantar, acropustulose infantil, bacteride pustular de Andrews e foliculite pustulosa eosinofílica. Uma breve revisão das dermatoses neutrofílicas em pacientes pediátricos também é realizada.
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Affiliation(s)
- Fernanda Razera
- Universidade Federal de Ciências da Saúde de Porto Alegre; Universidade Federal de Ciências da Saúde de Porto Alegre; Hospital Mãe de Deus, Brasil
| | - Gislaine Silveira Olm
- Hospital Mãe de Deus, Brasil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil
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Cedeno-Laurent F, Gómez-Flores M, Mendez N, Ancer-Rodríguez J, Bryant JL, Gaspari AA, Trujillo JR. New insights into HIV-1-primary skin disorders. J Int AIDS Soc 2011; 14:5. [PMID: 21261982 PMCID: PMC3037296 DOI: 10.1186/1758-2652-14-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 01/24/2011] [Indexed: 11/23/2022] Open
Abstract
Since the first reports of AIDS, skin involvement has become a burdensome stigma for seropositive patients and a challenging task for dermatologist and infectious disease specialists due to the severe and recalcitrant nature of the conditions. Dermatologic manifestations in AIDS patients act as markers of disease progression, a fact that enhances the importance of understanding their pathogenesis. Broadly, cutaneous disorders associated with HIV type-1 infection can be classified as primary and secondary. While the pathogenesis of secondary complications, such as opportunistic infections and skin tumours, is directly correlated with a decline in the CD4+ T cell count, the origin of the certain manifestations primarily associated with the retroviral infection itself still remains under investigation. The focus of this review is to highlight the immunological phenomena that occur in the skin of HIV-1-seropositive patients, which ultimately lead to skin disorders, such as seborrhoeic dermatitis, atopic dermatitis, psoriasis and eosinophilic folliculitis. Furthermore, we compile the latest data on how shifts in the cytokines milieu, impairments of the innate immune compartment, reactions to xenobiotics and autoimmunity are causative agents in HIV-1-driven skin diseases. Additionally, we provide a thorough analysis of the small animal models currently used to study HIV-1-associated skin complications, centering on transgenic rodent models, which unfortunately, have not been able to fully unveil the role of HIV-1 genes in the pathogenesis of their primarily associated dermatological manifestations.
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Malassezia Species: A Rare Cause of Invasive Fungal Infections in Immunocompromised Patients. CURRENT FUNGAL INFECTION REPORTS 2010. [DOI: 10.1007/s12281-010-0037-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Tragiannidis A, Bisping G, Koehler G, Groll AH. Minireview:Malasseziainfections in immunocompromised patients. Mycoses 2010; 53:187-95. [DOI: 10.1111/j.1439-0507.2009.01814.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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16
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Müller H, Eisendle K, Zelger B. Chronic recurrent follicular papules and plaques on the face. Clin Exp Dermatol 2010; 35:99-100. [DOI: 10.1111/j.1365-2230.2009.03230.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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[Malassezia folliculitis: characteristics and therapeutic response in 26 patients]. Ann Dermatol Venereol 2008; 134:823-8. [PMID: 18033060 DOI: 10.1016/s0151-9638(07)92824-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Malassezia folliculitis is most often described in patients living in hot and humid countries or in immunocompromised patients. Its frequency in France is unknown. We report 26 cases diagnosed at Saint-Louis Hospital between May 2002 and April 2004. The clinical features, the contributing factors, the results of direct mycological examination and/or histology and the efficacy of antifungal treatments were compared to the literature. PATIENTS AND METHODS The inclusion criteria were the presence of folliculitis on the trunk confirmed by direct microscopy and/or histopathology showing abundant yeast cells in the follicles. RESULTS Patients comprised 22 men and 4 women (M/F sex ratio: 5: 5) with a mean age of 46 years. Five patients (19%) were immunocompromised. In normal patients, the duration of folliculitis was long with a mean of 61 months. The eruption was typical, with follicular papules and superficial pustules distributed predominantly on the trunk. Itching was frequent (70%). Direct microscopy was more often positive than histology (89% vs 33%). Some sixty-five percent of the patients had been previously treated by topical or systemic antibiotics or anti-acne drugs, which was ineffective in all cases. Cure with topical ketoconazole, oral ketoconazole alone or in combination with topical ketoconazole occurred respectively in 12%, 75% and 75% of patients, but with consistent recurrence within 3 to 4 months after cessation of treatment. DISCUSSION Malassezia folliculitis is probably misdiagnosed, as suggested by the long time between onset and diagnosis and the high frequency of non-antifungal treatments prescribed. In our study, direct mycological examination provided more effective diagnosis than histology. Treatment is difficult especially because of the high frequency of relapses. CONCLUSION A diagnosis of Malassezia folliculitis should be considered in young adults or immunocompromised patients with an itching follicular eruption. Further therapeutic trials are needed due to the frequency of relapse.
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Marzano AV, Ramoni S, Alessi E, Caputo R. Generalized granuloma annulare and eruptive folliculitis in an HIV-positive man: resolution after antiretroviral therapy. J Eur Acad Dermatol Venereol 2007; 21:1114-6. [PMID: 17714140 DOI: 10.1111/j.1468-3083.2006.02103.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Budavari JM, Grayson W. Papular follicular eruptions in human immunodeficiency virus-positive patients in South Africa. Int J Dermatol 2007; 46:706-10. [PMID: 17614798 DOI: 10.1111/j.1365-4632.2007.03141.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Papular and follicular eruptions, such as papulopruritic eruption, eosinophilic folliculitis, and infective folliculitis, are relatively common disorders in patients infected with the human immunodeficiency virus (HIV). These conditions may show considerable clinical overlap. OBJECTIVE To assess the relative proportion of pruritic papular cutaneous eruptions in South Africans with HIV-associated dermatoses, and to correlate the clinical and histologic features of these lesions. METHODS The clinical and histologic features of papular follicular eruptions were correlated in 40 consecutive black HIV-positive patients who underwent skin biopsy. RESULTS The clinical features were similar in all patients and consisted of widespread papules and pustules involving the face, limbs, and trunk. The most common histologic finding was acute suppurative folliculitis, seen in 27 patients (67.5%). In most cases, no cause was found for the suppuration. Papulopruritic eruption of HIV was diagnosed in six patients (15%), HIV-associated eosinophilic folliculitis in four (10%), Pityrosporum folliculitis in two (5%), and acne in one (2.5%). Concordance between the initial clinical diagnosis and the final histopathologic diagnosis was achieved in only 27.5% of cases. CONCLUSION Skin biopsy remains an important adjunct to the correct diagnosis and classification of papular and follicular eruptions in HIV-positive patients.
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Affiliation(s)
- Judith M Budavari
- Division of Dermatology, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Kuwano Y, Watanabe R, Fujimoto M, Komine M, Asahina A, Tsukada N, Tamaki K. Treatment of HIV-associated eosinophilic pustular folliculitis with narrow-band UVB. Int J Dermatol 2007; 45:1265-7. [PMID: 17040467 DOI: 10.1111/j.1365-4632.2006.03072.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Nervi SJ, Schwartz RA, Dmochowski M. Eosinophilic pustular folliculitis: a 40 year retrospect. J Am Acad Dermatol 2006; 55:285-9. [PMID: 16844513 DOI: 10.1016/j.jaad.2006.02.034] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Revised: 12/28/2005] [Accepted: 02/19/2006] [Indexed: 11/26/2022]
Abstract
Eosinophilic pustular folliculitis (EPF) is a noninfectious eosinophilic infiltration of hair follicles first described 40 years ago. There are 3 variants: classic EPF, immunosuppression-associated (mostly HIV-related), and infancy-associated EPF. EPF has been classified as an AIDS-defining illness. In both children and adults EPF should be viewed as a possible cutaneous sign of immunosuppression. However, it may also be seen in persons with normal immune status. We review EPF on the 40th anniversary of its original description.
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Affiliation(s)
- Stephen J Nervi
- Dermatology, New Jersey Medical School, Newark 07103-2714, USA
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Parker SRS, Parker DC, McCall CO. Eosinophilic folliculitis in HIV-infected women: case series and review. Am J Clin Dermatol 2006; 7:193-200. [PMID: 16734507 DOI: 10.2165/00128071-200607030-00006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Dermatologic conditions are often presenting signs of HIV infection and may be the sole cause of morbidity in patients who have otherwise stable HIV disease. Eosinophilic folliculitis is a pruritic, follicular eruption that typically manifests late in the course of HIV infection. Most published reports of eosinophilic folliculitis have been in HIV-infected men. In those reports, a characteristic truncal distribution was present, with involvement of the head, neck, and upper extremities commonly seen as well. The objective of this study was to better characterize the presentation of eosinophilic folliculitis in women. METHODS We conducted a retrospective chart review of six HIV-seropositive women with eosinophilic folliculitis previously seen in our dermatology clinics. We also reviewed the literature for cases of eosinophilic folliculitis in women and for clinical and therapeutic aspects of the condition, particularly in women. RESULTS In our case series, we found that eosinophilic folliculitis in women may predominantly affect the face and mimic acne excoriée. A review of the literature of HIV-associated eosinophilic folliculitis in women supports these findings. Regarding treatment, many therapies are available, but none is uniformly effective. CONCLUSION Given the dramatic rise in the incidence of HIV infection in women, who now represent nearly 50% of adults living worldwide with HIV/AIDS, a heightened awareness of HIV-related dermatoses in women is essential. HIV-associated eosinophilic folliculitis should be considered in the differential diagnosis of chronic, pruritic, papular facial eruptions in females.
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Affiliation(s)
- Sareeta R S Parker
- Department of Dermatology, Emory University School of Medicine, and Grady Health System, Atlanta, Georgia 30322, USA
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Abstract
In the newborn, there exists a wide spectrum of pustular skin diseases. These range from transitory, benign adaptation disorders up to systemic, life threatening illnesses. In 30-60% of newborns pustules are observed in association with the relatively harmless Erythema toxicum, the origin of which is still unknown today. It is necessary to differentiate this from the pustular diseases which may be of infectious or non-infectious nature and which require therapy. Typical pathogens include Malassezia furfur, Staphylococci, Streptococci, Candida spp. and the herpes virus group.
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MESH Headings
- Diagnosis, Differential
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/therapy
- Practice Guidelines as Topic
- Practice Patterns, Physicians'
- Pyoderma/congenital
- Pyoderma/diagnosis
- Pyoderma/epidemiology
- Pyoderma/therapy
- Skin Diseases, Infectious/congenital
- Skin Diseases, Infectious/diagnosis
- Skin Diseases, Infectious/epidemiology
- Skin Diseases, Infectious/therapy
- Skin Diseases, Papulosquamous/congenital
- Skin Diseases, Papulosquamous/diagnosis
- Skin Diseases, Papulosquamous/epidemiology
- Skin Diseases, Papulosquamous/therapy
- Treatment Outcome
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Almagro M, Del Pozo J, García-Silva J, Pérez-García M, Rodríguez-Lozano J, Pértega S, Fonseca E. Acne is not a stigma of HIV infection: a review of 36 patients. Dermatology 2005; 211:114-7. [PMID: 16088156 DOI: 10.1159/000086439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2004] [Accepted: 11/12/2004] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Several diseases with follicular occlusion have been described in HIV-infected patients and can appear isolated or associated with each other in an independent disease named 'HIV-associated follicular syndrome'. Worsening of cutaneous lesions during the course of infection in patients with previous acne vulgaris, late onset or severe forms of acne have been reported in HIV-infected patients. PATIENTS AND METHODS A prospective study of 335 HIV-infected patients was performed in our hospital. A meticulous dermatological exploration in all patients was made, and multiple data were stored into a Microsoft Access 97 program. Patients diagnosed as having acne were considered separately, and we studied their characteristics. A statistical analysis with SPSS 9.0 (Statistical Package for the Social Sciences) was performed. RESULTS Thirty-six patients (10.8%) were diagnosed as having acne. Papulopustular lesions were the most frequent clinical presentation. Most lesions were localized on the face or on the back, and 80% of patients had mild to moderate acne; 40% of them required no treatment and the remainder was treated with topical measures, oral antibiotics and isotretinoin. 85% of cases reported the onset of acne during adolescence or before HIV infection and without any relationship with this disease. No relation between acne intensity and stage of HIV infection was observed. A multivariate analysis showed that the most important variable was age. DISCUSSION In contrast to previous reports, no greater intensity or modifications in acne lesions were observed in our HIV-infected patients during the course of the disease. In the majority of cases, cutaneous lesions started before HIV infection, during adolescence, and the most important factor for suffering from acne was young age. In contrast to data reported in the literature, no relation of acne lesions to CD4 lymphocyte count or AIDS case criteria was found in our patients. CONCLUSIONS Acne in HIV-infected patients has characteristics similar to those in non-HIV-infected patients. The age is the most important factor for the appearance of lesions that usually develop during adolescence. Acne lesions are not modified by HIV infection, and no relationship with the severity of HIV infection has been observed.
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Affiliation(s)
- M Almagro
- Department of Dermatology, Juan Canalejo Hospital, La Coruña, Spain.
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25
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Moyle M, Woolley IJ, Thevarajan I, Korman TM. Eosinophilic folliculitis: an example of 'immune reconstitution folliculitis'? AIDS 2004; 18:2350-2. [PMID: 15577558 DOI: 10.1097/00002030-200411190-00026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gupta AK, Batra R, Bluhm R, Boekhout T, Dawson TL. Skin diseases associated with Malassezia species. J Am Acad Dermatol 2004; 51:785-98. [PMID: 15523360 DOI: 10.1016/j.jaad.2003.12.034] [Citation(s) in RCA: 254] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The yeasts of the genus Malassezia have been associated with a number of diseases affecting the human skin, such as pityriasis versicolor, Malassezia (Pityrosporum) folliculitis, seborrheic dermatitis and dandruff, atopic dermatitis, psoriasis, and--less commonly--with other dermatologic disorders such as confluent and reticulated papillomatosis, onychomycosis, and transient acantholytic dermatosis. Although Malassezia yeasts are a part of the normal microflora, under certain conditions they can cause superficial skin infection. The study of the clinical role of Malassezia species has been surrounded by controversy because of their fastidious nature in vitro, and relative difficulty in isolation, cultivation, and identification. Many studies have been published in the past few years after the taxonomic revision carried out in 1996 in which 7 species were recognized. Two new species have been recently described, one of which has been isolated from patients with atopic dermatitis. This review focuses on the clinical, mycologic, and immunologic aspects of the various skin diseases associated with Malassezia. It also highlights the importance of individual Malassezia species in the different dermatologic disorders related to these yeasts.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, Sunnybrook and Women's College Health Science Center (Sunnybrook site) and the University of Toronto, Ontario, Canada.
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Ota M, Shimizu T, Hashino S, Shimizu H. Eosinophilic folliculitis in a patient after allogeneic bone marrow transplantation: case report and review of the literature. Am J Hematol 2004; 76:295-6. [PMID: 15224372 DOI: 10.1002/ajh.20080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We describe a patient with eosinophilic folliculitis (EF) that developed 3 months after allogeneic bone marrow transplantation (BMT) for chronic myelogenous leukemia. Skin biopsy specimen revealed numerous eosinophil infiltrations from the hair follicles to the sebaceous glands. No sign of skin graft-versus-host disease (GVHD) was found. The skin lesions and peripheral eosinophilia subsided within 5 weeks. In the following 8 months, the rash did not recur and GVHD has not developed. Taken together with previous reports, the present case demonstrates that it is important to recognize this distinct skin condition to avoid an inference that it may manifest itself as one of the signs of skin GVHD.
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Affiliation(s)
- Mitsuhito Ota
- Department of Dermatology, Hokkaido University Graduate School of Medicine, N-15 W-7, Sapporo 060-8638, Japan.
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Abstract
Folliculitis is an inflammatory reaction in the superficial aspect of the hair follicle and can involve the follicular opening or the perifollicular hair follicles. The pilosebaceous unit of the follicle is divided into three compartments: the infundibulum (superficial part, outlined by the sebaceous duct), the isthmus (between the sebaceous duct and arrector pili protuberance), and the inferior segment (stem and hair bulb). This anatomical scheme forms the basis for any evaluation of the clinical manifestations of folliculitis. Most of the follicular conditions can be classified according to their anatomical location and histopathologic patterns. Clinically, the inflammation manifests as 1mm-wide vesicles, pustules, or papulopustules in acute cases; however, hyperkeratosis and keratotic plug formations are indicative of a chronic process. The presence of superficial pustules does not always imply an infectious origin, as there are many noninfectious types of folliculitis. In this review, we describe the different types of folliculitis based on their etiology, clinical manifestation, and treatment. We also discuss some newly described disorders and the latest information on their treatment.
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Abstract
With the advent of highly active antiretroviral therapy (HAART), life-threatening opportunistic infection has become less common in patients with HIV infection and longevity has increased dramatically. With increased longevity, the problems of living with a chronic disease have become more prominent in this patient population. Disorders such as fat redistribution and metabolic abnormalities can result from antiviral medications and from HIV disease itself. Pruritus is one of the most common symptoms encountered in patients with HIV. The spectrum of skin diseases in such patients encompasses dermatoses of diverse etiologies; a few are peculiar to patients with HIV while others are not. Some of these conditions may cause severe and sometimes intractable pruritus that provokes scratching, picking, disfigurement, sleep loss, and significant psychological stress. Moreover, the expense of ongoing medical treatments can be daunting. Skin rash can sometimes be the initial presentation of HIV infection or serve as a harbinger of disease progression. Causes of pruritus include skin infections, infestations, papulosquamous disorders, photodermatitis, xerosis, drug reactions, and occasionally lymphoproliferative disorders. Drug eruptions are particularly common in patients who are HIV positive, presumably as a result of immune dysregulation, altered drug metabolism, and polypharmacy. Itching can also result from systemic diseases such as chronic renal failure, liver disease, or systemic lymphoma. Workup of pruritus should include a careful examination of the skin, hair, nails, and mucous membranes to establish a primary dermatologic diagnosis. If no dermatologic cause is found, a systemic cause or medication-related etiology should be sought. Idiopathic HIV pruritus is a diagnosis of exclusion and should only be considered when a specific diagnosis cannot be established. The management of HIV-associated pruritus should be directed at the underlying condition. Phototherapy has been found to be useful in the treatment of several HIV-associated dermatoses and idiopathic pruritus as well. Unfortunately, some of the treatments that have been suggested for patients with HIV are anecdotal or based on small uncontrolled studies. The last decade has seen a surge in the utilization of HAART which, to some degree, reconstitutes the immune system and ameliorates some dermatologic diseases. On the other hand, some skin diseases flare temporarily when HAART is started. Unless frank drug allergy is suspected, HAART does not need to be stopped.
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Affiliation(s)
- Fiza Singh
- Mount Sinai Medical School of Medicine, New York, New York 10029, USA
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Lee JYY, Tsai YM, Sheu HM. Ofuji's disease with follicular mucinosis and its differential diagnosis from alopecia mucinosa. J Cutan Pathol 2003; 30:307-13. [PMID: 12753170 DOI: 10.1034/j.1600-0560.2003.00076.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Ofuji's disease (OD) or eosinophilic pustular folliculitis and human immunodeficiency virus-associated eosinophilic folliculitis (HIV-EF) both show eosinophil-rich folliculocentric infiltrates, and it is not clear whether they are distinguishable pathologically. Follicular mucinosis (FM) has been observed in lesions of EF; such cases need to be differentiated from alopecia mucinosa (AM). METHODS We compared various pathologic features in 13 cases of OD, 10 cases of non-OD-typed papular EF (seven HIV-positive and three HIV-negative), and five cases of AM. RESULTS All cases of EF showed eosinophilic infiltrates affecting mainly the isthmus or/and sebaceous gland. Eosinophil-rich pilosebaceous pustules or/and microabscesses were noted in 69% of the biopsy specimens of OD, 73% of papular EF, 71% of HIV-EF, and 0% of AM. Mucin deposits, often abundant, were found in sebaceous lobules or/and isthmus in 41% of OD and 100% of AM. Compared with AM, OD with FM tended to show more numerous eosinophils, less abundant mucin, and most significantly, eosinophilic infundibular pustule or sebaceous microabscess. CONCLUSION Our study suggests that OD and HIV-EF are indistinguishable pathologically and the diagnosis requires clinical correlation. FM was not uncommonly seen in lesions of OD. OD with FM may be difficult to differentiate from FM, especially in cases presenting with non-annular or non-pustular lesions, but the diagnosis might be facilitated by finding eosinophil-rich pustule, microabscess, or infiltrate in pilosebaceous units microscopically.
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Affiliation(s)
- J Yu-Yun Lee
- Department of Dermatology, National Cheng Kung University, Tainan, Taiwan.
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Almagro Sánchez M, García Silva J, Fonseca Capdevila E. Manifestaciones cutáneas actuales de la infección por el VIH. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s0213-9251(02)72538-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jansen T, Kastner U, Kreuter A, Altmeyer P. Rosacea-like demodicidosis associated with acquired immunodeficiency syndrome. Br J Dermatol 2001; 144:139-42. [PMID: 11167695 DOI: 10.1046/j.1365-2133.2001.03794.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present a 35-year-old patient with acquired immunodeficiency syndrome who had demodicidosis on his face, characterized by multiple papules and papulopustules, associated pruritus, numerous mites on skin-surface biopsy and in biopsy specimens, and rapid response to topical treatment with permethrin. It seems likely that Demodex infestation does not manifest unless local or systemic immune function is altered, leading to the proliferation of the organism and subsequent disease.
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Affiliation(s)
- T Jansen
- Department of Dermatology and Allergology, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
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