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Ottavi M, Velin M, Cardot Leccia N, Passeron T. Successful Treatment of Eosinophilic Pustular Folliculitis With Dupilumab. JAMA Dermatol 2024; 160:114-115. [PMID: 37910114 DOI: 10.1001/jamadermatol.2023.4305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
This case report describes a woman in her 20s who presented with an itchy erythematous-papulo-pustular eruption of the scalp for 3 months with progressive centrifugal extension to the face and was diagnosed with Ofuji disease.
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Affiliation(s)
- Marie Ottavi
- Service de Dermatologie, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Marine Velin
- Service de Dermatologie, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Nathalie Cardot Leccia
- Service d'Anatomo-pathologie, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Thierry Passeron
- Service de Dermatologie, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
- INSERM U1065, C3M, Nice, France
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2
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Kinoshita Y, Kono T, Ansai SI, Saeki H. An aggressive case of granulomatous eosinophilic pustular folliculitis on the face. JAAD Case Rep 2019; 5:237-239. [PMID: 30847380 PMCID: PMC6389553 DOI: 10.1016/j.jdcr.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yuri Kinoshita
- Department of Dermatology, Nippon Medical School Chiba Hokuso Hospital, Chiba, Japan
- Correspondence to: Yuri Kinoshita, MD, MSc, Department of Dermatology, Nippon Medical School Chiba Hokuso Hospital, 1715 Yabukari, Inzai, Chiba, 270-1613, Japan.
| | - Takeshi Kono
- Department of Dermatology, Nippon Medical School Chiba Hokuso Hospital, Chiba, Japan
| | - Shin-ichi Ansai
- Division of Dermatology and Dermatopathology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Japan
| | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
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3
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Liu XK, Li J. Annular plaques on the trunk. Assoc Med J 2019. [DOI: 10.1136/bmj.k5412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nomura T, Katoh M, Yamamoto Y, Kabashima K, Miyachi Y. Eosinophilic pustular folliculitis: the transition in sex differences and interracial characteristics between 1965 and 2013. J Dermatol 2015; 42:343-52. [PMID: 25675987 DOI: 10.1111/1346-8138.12783] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
Eosinophilic pustular folliculitis (EPF) is characterized by a non-infectious infiltration of eosinophils in the hair follicles. It has three variants: (i) classic EPF; (ii) immunosuppression-associated EPF, which herein is subdivided into HIV-associated (IS/HIV) and non-HIV-associated (IS/non-HIV); and (iii) infancy-associated EPF (I-EPF). The rarity of EPF has hindered our understanding of this entity. To examine the characteristics of EPF, with respect to age, sex, race, and chronology, published in case reports to date, we queried PubMed using the following terms: ("eosinophilic pustular folliculitis" [All Fields] OR "eosinophilic folliculitis" [All Fields]) AND ("1965/1/1" [PDAT]: "2013/12/31" [PDAT]). Additional Japanese cases were collected from Igaku Chuo Zasshi through Ichushi-Web, JDream III, and secondhand quotations from domestic periodicals published in Japan. Proceedings were excluded. The PubMed search produced 275 citations containing 358 cases of EPF (224 men, 132 women, and two of unspecified sex); these cases involved classic EPF (101 Japanese and 81 non-Japanese), IS/HIV (4 Japanese and 85 non-Japanese), IS/non-HIV (4 Japanese and 20 non-Japanese), and I-EPF (4 Japanese and 59 non-Japanese). Ichushi generated an additional 148 citations containing 207 cases of Japanese (148 men and 59 women), which included cases of classic EPF (181 cases), IS/HIV (14 cases), IS/non-HIV (9 cases), and I-EPF (3 cases). There was no sex difference in the classic EPF cases reported between 2003 and 2013, whereas IS/HIV, IS/non-HIV, and I-EPF were predominated by men. There is room for reconsideration of sex differences, particularly with regard to classic EPF. The rarity and specificity of I-EPF in Japan may reflect a state of uncertainty about this entity.
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Affiliation(s)
- Takashi Nomura
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Dermatology, Ijinkai Takeda General Hospital, Kyoto, Japan
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5
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Yamamoto Y, Nomura T, Kabashima K, Miyachi Y. Clinical Epidemiology of Eosinophilic Pustular Folliculitis: Results from a Nationwide Survey in Japan. Dermatology 2014; 230:87-92. [DOI: 10.1159/000368774] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/19/2014] [Indexed: 11/19/2022] Open
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Kataoka N, Satoh T, Hirai A, Saeki K, Yokozeki H. Indomethacin inhibits eosinophil migration to prostaglandin D2 : therapeutic potential of CRTH2 desensitization for eosinophilic pustular folliculitis. Immunology 2013; 140:78-86. [PMID: 23582181 DOI: 10.1111/imm.12112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 04/09/2013] [Accepted: 04/10/2013] [Indexed: 11/30/2022] Open
Abstract
Indomethacin is a cyclo-oxygenase inhibitor, and shows therapeutic potential for various eosinophilic skin diseases, particularly eosinophilic pustular folliculitis. One of the unique characteristics of indomethacin is that, unlike other non-steroidal anti-inflammatory drugs, it is a potent agonist of chemoattractant receptor-homologous molecule expressed on T helper type 2 cells (CRTH2), a receptor for prostaglandin D2 (PGD2 ). This study investigated the pharmacological actions of indomethacin on eosinophil migration to clarify the actual mechanisms underlying the therapeutic effects of indomethacin on eosinophilic pustular folliculitis. Eosinophils exhibited chemokinetic and chemotactic responses to both PGD2 and indomethacin through CRTH2 receptors. Pre-treatment of eosinophils with indomethacin greatly inhibited eosinophil migration to PGD2 and, to a much lesser extent, to eotaxin (CCL11); these effects could be mediated by homologous and heterologous desensitization of eosinophil CRTH2 and CCR3, respectively, by agonistic effects of indomethacin on CRTH2. Indomethacin also cancelled a priming effect of Δ(12) -PGJ2 , a plasma metabolite of PGD2 , on eosinophil chemotaxis to eotaxin. Indomethacin down-modulated cell surface expression of both CRTH2 and CCR3. Hair follicle epithelium and epidermal keratinocytes around eosinophilic pustules together with the eccrine apparatus of palmoplantar lesions of eosinophilic pustular folliculitis were immunohistochemically positive for lipocalin-type PGD synthase. Indomethacin may exert therapeutic effects against eosinophilic skin diseases in which PGD2 -CRTH2 signals play major roles by reducing eosinophil responses to PGD2 .
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Affiliation(s)
- Naoko Kataoka
- Department of Dermatology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
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7
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Patel N, Laguda B, Roberts N, Francis N, Agnew K. Treatment of eosinophilic pustulosis of infancy with topical tacrolimus. Br J Dermatol 2012; 167:1189-91. [DOI: 10.1111/j.1365-2133.2012.11045.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Katoh M, Nomura T, Miyachi Y, Kabashima K. Eosinophilic pustular folliculitis: A review of the Japanese published works. J Dermatol 2012; 40:15-20. [DOI: 10.1111/1346-8138.12008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 08/27/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Mayumi Katoh
- Department of Dermatology; Kyoto University Graduate School of Medicine; Kyoto; Japan
| | - Takashi Nomura
- Department of Dermatology; Kyoto University Graduate School of Medicine; Kyoto; Japan
| | - Yoshiki Miyachi
- Department of Dermatology; Kyoto University Graduate School of Medicine; Kyoto; Japan
| | - Kenji Kabashima
- Department of Dermatology; Kyoto University Graduate School of Medicine; Kyoto; Japan
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Lim HL, Chong WS. Recalcitrant eosinophilic pustular folliculitis of Ofuji with palmoplantar pustulosis: dramatic response to narrowband UVB phototherapy. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2012; 28:219-21. [DOI: 10.1111/j.1600-0781.2012.00665.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Uchiyama M, Mitsuhashi Y, Okubo Y, Tsuboi R. Eosinophilic pustular folliculitis (Ofuji's disease) without macroscopic pustules. Int J Dermatol 2011; 51:50-2. [PMID: 21790551 DOI: 10.1111/j.1365-4632.2011.04934.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Eosinophilic pustular folliculitis (EPF), first described by Ofuji et al. in 1970, is a rare dermatosis characterized by pruritic papules and pustules on circinate erythematous plaques with eosinophilic infiltration in and around the hair follicle. METHODS AND RESULTS We report three cases of EPF that showed no macroscopic pustules during the total observation period. Histopathological examination revealed eosinophilic infiltration in and around the hair follicle in the lower dermis and subcutis. CONCLUSIONS EPF consists of clinical variants, one of which lacks obvious pustules.
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Affiliation(s)
- Masaki Uchiyama
- Department of Dermatology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
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11
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Mizuashi M, Kuramoto Y, Aiba S, Tagami H. Juvenile localized annular pustular psoriasis developing severe exacerbation after topical indomethacin application. Int J Dermatol 2010; 48:1262-4. [PMID: 20064190 DOI: 10.1111/j.1365-4632.2009.04100.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Howes R, Girgis L, Kossard S. Eosinophilic annular erythema: A subset of Wells' syndrome or a distinct entity? Australas J Dermatol 2008; 49:159-63. [DOI: 10.1111/j.1440-0960.2008.00456.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Leiferman KM, Gleich GJ, Peters MS. Dermatologic Manifestations of the Hypereosinophilic Syndromes. Immunol Allergy Clin North Am 2007; 27:415-41. [PMID: 17868857 DOI: 10.1016/j.iac.2007.07.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Skin is a commonly affected organ in hypereosinophilic syndromes (HES). Cutaneous lesions may be an important presenting sign, may be extremely debilitating, and often reflect disease activity in HES. Recognition of dermatologic manifestations is important in approaching diagnosis and treatment of HES. This article reviews cutaneous involvement in HES and other eosinophil-associated skin diseases.
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Affiliation(s)
- Kristin M Leiferman
- Department of Dermatology, 4B454 School of Medicine, University of Utah Health Sciences Center, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132-2409, USA.
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Arca E, Köse O, Karslioğlu Y, Taştan HB, Demiriz M. Bullous eosinophilic cellulitis succession with eosinophilic pustular folliculitis without eosinophilia. J Dermatol 2007; 34:80-5. [PMID: 17204108 DOI: 10.1111/j.1346-8138.2007.00222.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Eosinophilic cellulitis is characterized clinically by an acute dermatitis resembling cellulitis with unknown etiology. Eosinophilic pustular folliculitis is also a rare inflammatory dermatosis characterized by recurrent crops of erythematous follicular papulopustules that coalesce to form annular plaques with unclear etiopathogenesis. We describe a 20-year-old white male who had vesiculobullous and plaque-like lesions on the hands and feet and was diagnosed with bullous eosinophilic cellulitis clinically and histologically without any etiological agents. Following therapy with oral corticosteroid and oral tetracycline capsules, the lesions disappeared. After a 2-month asymptomatic period, the patient developed pruritic follicular papules and pustules on the lower and upper extremities and upper back. Stool examination revealed Gierdia intestinalis eggs. The patient had complete clearance with treatment of ornidazol for 2 weeks and indomethacin for 2 months. This is the first report of bullous eosinophilic cellulitis coexisting with eosinophilic pustular folliculitis without eosinophilia in the English published work.
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Affiliation(s)
- Ercan Arca
- Department of Dermatology, Gülhane School of Medicine, Ankara, Turkey
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Fallah H, Dunlop K, Kossard S. Successful treatment of recalcitrant necrotizing eosinophilic folliculitis using indomethacin and cephalexin. Australas J Dermatol 2006; 47:281-5. [PMID: 17034473 DOI: 10.1111/j.1440-0960.2006.00296.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 56-year-old man presented with a 4-month history of a painful and pruritic eruption consisting of crusted plaques and blisters on his face, scalp and chest. The patient suffered from headaches and malaise but was afebrile. Two skin biopsies revealed an epidermis which was eroded and covered by locules of serum and neutrophils. In the underlying dermis, there was a marked mixed inflammatory reaction including lymphocytes, neutrophils and numerous eosinophils. There was exocytosis of eosinophils into several follicles with areas of follicular mucinosis. A diagnosis of necrotizing eosinophilic folliculitis was made based upon the clinical and histopathological findings. The diagnosis was supported by the rapid response to a combination of indomethacin and cephalexin. The patient has taken continuous indomethacin (with rabeprazole and misoprostol cover) and cephalexin for 2 years. If treatment is withdrawn he experiences a flare of his disease within 2 weeks. This case highlights the potentially chronic nature of this disease.
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Affiliation(s)
- Haady Fallah
- Skin and Cancer Foundation Australia, Darlinghurst, New South Wales, Australia.
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16
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Gesierich A, Herzog S, Grunewald SM, Tappe D, Bröcker EB, Schön MP. Eosinophilic folliculitis in a Caucasian patient: association with toxocariasis? J Eur Acad Dermatol Venereol 2006; 20:1317-21. [PMID: 17062052 DOI: 10.1111/j.1468-3083.2006.01762.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sterile eosinophilic folliculitis, a clinical entity first described by Ofuji in 1970, is a rather rare skin disorder, in particular in the non-Asian population. We report the first case of eosinophilic folliculitis associated with toxocariasis in a Caucasian patient. Topical and systemic anti-inflammatory and antiphlogistic therapy along with systemic antihelminthic treatment resulted in complete remission of the skin lesions. In addition, there was a marked decrease of antibodies to Toxocara antigens in the patient's serum following antihelminthic therapy. Given that (I) some cases of eosinophilic folliculitis have been reported which were associated with infestation with metazoan parasites; (2) infestations with the roundworm Toxocara canis are known to induce eosinophilic reactions in some tissues; and (3) therapy-induced remission of eosinophilic folliculitis was accompanied by a decrease of Toxocara-directed antibodies in the patient's serum, we propose that there is an aetiopathogenic link between toxocariasis and eosinophilic folliculitis in this patient.
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Affiliation(s)
- A Gesierich
- Department of Dermatology and Venereology, University of Würzburg, Würzburg, Germany
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17
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García Río I, Díaz-Ramón JL, González-Pérez R, Arregui Murua MA, Trébol Urra I, Tamayo Victor C, Soloeta-Arechavala R. [Ofuji's disease: description of a case]. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:391-4. [PMID: 16956519 DOI: 10.1016/s0001-7310(06)73426-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Eosinophilic pustular folliculitis (EPF) is a rare, chronic disease of unknown cause, characterized by itchy papules or pustules and an infiltration of eosinophiles in the biopsy. EPF occurs rarely outside Japan and very few cases have been described in non-Japanese race people. The causes of the disease and its definitive treatment have not yet been established. In our patient, the presence of subcorneal pustules in the biopsies initially favored a diagnosis of pustulosis and several biopsies were necessary before a diagnosis of EPF was reached. A new case of EPF recently presented at our clinic and we have carried out an extensive revision of the disease.
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Affiliation(s)
- I García Río
- Servicio de Dermatología, Hospital Santiago Apóstol, Vitoria-Gasteiz, España.
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18
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Teraki Y, Nishikawa T. Skin diseases described in Japan 2004. In Japan beschriebene Dermatosen 2004. J Dtsch Dermatol Ges 2005; 3:9-25. [PMID: 16353745 DOI: 10.1046/j.1439-0353.2005.04076.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
During the last century of modern dermatology, more than 30 skin diseases have been described first by physicians from Japan. Many of those conditions were disorders of pigmentation and keratinization, which are quite common in Oriental patients. Since the late 1940s, a number of skin diseases first reported in Japan have gained attention internationally among them being Kimura disease, hypomelanosis of Ito, Kawasaki disease, adult T-cell leukemia/ lymphoma, eosinophilic pustular folliculitis, prurigo pigmentosa, and Ofuji's papuloerythroderma. In this article, we review skin diseases that were first established as distinct entities in Japan, in order to familiarize readers of the Western literature with these conditions.
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Affiliation(s)
- Yuichi Teraki
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
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Kawaguchi M, Mitsuhashi Y, Kondo S. Successful treatment of eosinophilic pustular folliculitis with topical tacrolimus. Int J Dermatol 2004; 43:608-10. [PMID: 15304190 DOI: 10.1111/j.1365-4632.2004.02109.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We present two cases of Eosinophilic pustular folliclulitis (EPF) who were successfully treated with topical tacrolimus. Indomethacin is the most frequently used agent for the treatment of EPF, however, tacrolimus ointment may become the treatment of choice for patients with EPF.
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Affiliation(s)
- Masakazu Kawaguchi
- Department of Dermatology, Yamagata University School of Medicine, Iida-Nishi, Japan.
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20
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Brazzelli V, Barbagallo T, Prestinari F, Ciocca O, Vassallo C, Borroni G. HIV seronegative eosinophilic pustular folliculitis successfully treated with doxicycline. J Eur Acad Dermatol Venereol 2004; 18:467-70. [PMID: 15196164 DOI: 10.1111/j.1468-3083.2004.00948.x] [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: 11/28/2022]
Abstract
Eosinophilic pustular folliculitis (EPF) is an unusual disease, first described in adult East Asians in 1970 by Ofuji. It is characterized by follicular papules and pustules tending to coalesce and form plaques involving the trunk, face and extremities. In recent years, it has been often associated with human immunodeficiency virus (HIV) infection or with immunosuppressed and/or oncohaematological patients. EPF has been described in immunocompetent adult caucasian patients only occasionally. The diagnosis requires clinical and microbiological features such as sterile folliculitis and histopathological findings characterized by folliculitis and perifolliculitis with eosinophilic infiltrate. We describe an HIV seronegative caucasian male with EPF, allergic to non-steroidal anti-inflammatory drugs and indomethacin, treated with oral doxicycline. The treatment led to the complete remission of the lesions within 2 months.
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Affiliation(s)
- V Brazzelli
- Clinica Dermatologica, Università di Pavia, IRCCS-Policlinico S. Matteo, Piazza C. Golgi 2, 27100 Pavia, Italy.
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Ellis E, Scheinfeld N. Eosinophilic pustular folliculitis: a comprehensive review of treatment options. Am J Clin Dermatol 2004; 5:189-97. [PMID: 15186198 DOI: 10.2165/00128071-200405030-00007] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Eosinophilic pustular folliculitis (EPF), also known as Ofuji disease, is a disease that manifests with follicular papules or pustules. Its variants include a classic type that occurs most commonly in Japan, an HIV-associated type, an infantile type, a type that occurs on the palms and soles, a rare medication-associated variant, and a rare neoplasia-associated variant.A wide range of medications has been used to treat EPF. Topical corticosteroids are the first-line treatment option for EPF. Topical tacrolimus seems to be useful initial therapy as well. Oral indometacin (50-75 mg/day) is an effective treatment of classic EPF although it can induce peptic ulcers. For treatment of HIV-associated EPF when topical corticosteroids and indometacin do not work, various other treatments should be considered. These treatment options include cetirizine 20-40 mg/day, metronidazole 250 mg three times a day, itraconazole starting at a dosage of 200 mg/day and increasing to 300-400 mg/day, and topical permethrin. If these treatments do not work phototherapy with UVB is the 'gold standard' of treatment and is often curative. Treatments with less certain risk-benefit ratios but with some efficacy include PUVA (psoralen + UVA) photochemotherapy, oral corticosteroids, synthetic retinoids (i.e. isotretinoin 1 mg/kg/day), and acitretin (0.5 mg/kg/day), oral cyclosporine (ciclosporine) 5 mg/kg/day, interferon (IFN)-alpha-2b, and IFNgamma. Minocycline 100mg twice daily and dapsone 50-100mg twice daily have been used with some effect. The use of highly active antiretroviral therapy for HIV has resulted in the amelioration of EPF as CD4 cell counts rise above 250/mm(3). The diversity of clinical presentations and affected populations make it seem that EPF is a reaction pattern as much as a disease and that therapy should be tailored to the variant of EPF and the underlying etiology.
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Affiliation(s)
- Elliot Ellis
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Abstract
A 23-year-old woman presented with a 2-week history of an extensive facial eruption consisting of markedly crusted arciform plaques covered with a haemorrhagic eschar that commenced as pruritic follicular pustules. These were associated with facial oedema but no systemic symptoms or fever. Two skin biopsies revealed prominent tissue eosinophilia with eosinophilic folliculitis and areas of follicular mucinosis, as well as haemorrhagic scale crust over the surface. The clinical and histological findings may represent an example of a necrotizing variant of eosinophilic folliculitis that has recently been reported in atopic individuals. This patient, however, did not have evidence of atopy and appeared to have a florid form of Ofuji's disease that responded rapidly to indomethacin treatment.
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Affiliation(s)
- Steven Kossard
- Skin and Cancer Foundation Australia, Sydney, New South Wales, Australia.
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23
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Tang MBY, Tan E, Chua SH. Eosinophilic pustular folliculitis (Ofuji's disease) in Singapore: a review of 23 adult cases. Australas J Dermatol 2003; 44:44-7. [PMID: 12581081 DOI: 10.1046/j.1440-0960.2003.00636.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The case records of 23 patients with classic eosinophilic pustular folliculitis (EPF), or Ofuji's disease, seen at the National Skin Centre in Singapore, from 1990 to 2001 were reviewed. All patients had clinical and histopathological findings consistent with EPF. There were eight men and 15 women (ratio 1:1.6). The mean age at presentation was 35 years. There was a marked predilection for Chinese patients (87%), with a racial distribution of 20:2:1 of Chinese, Malay and Indian patients, respectively. The most frequent site of occurrence was the face, particularly over both cheeks. The majority of patients (90%) treated with oral indomethacin had a good response within 2-4 weeks. Relapses were frequent in 82.6% of patients and maintenance with indomethacin or ketoprofen was beneficial. Eosinophilic pustular folliculitis is a rare but important disease entity presenting with recurrent indurated erythematous papulopustules and plaques on the face. Increased awareness of this condition is important as it can mimic many other conditions presenting as red plaques on the face.
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