Eosinophilic pustular folliculitis: the transition in sex differences and interracial characteristics between 1965 and 2013

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.

[Ofuji's disease: description of a case]

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.

Ofuji's disease: a report on 20 patients with clinical and histopathologic analysis

BACKGROUND

Ofuji's disease, also referred to as classic eosinophilic pustular folliculitis, is a rare dermatosis of unknown origin for which there is no uniformly effective treatment.

OBJECTIVES AND METHODS

Twenty patients with Ofuji's disease (classic eosinophilic pustular folliculitis) evaluated in our department from January 1978 to June 1999 were studied clinically and histopathologically. Laboratory data, treatments, and clinical courses were evaluated in 12 of these individuals.

RESULTS

Nissl modified staining revealed moderate increases of mast cells around hair follicles and sebaceous glands in all 20 patients; the majority of the infiltrating mast cells were tryptase-positive and chymase-negative. Eight of 11 patients treated with oral indomethacin responded completely.

CONCLUSIONS

Indomethacin is an effective therapy for Ofuji's disease. Tryptase-positive and chymase-negative mast cells might play some role in the pathogenesis of Ofuji's disease.

Two cases of eosinophilic pustular folliculitis treated by acemetacin

The report deals with two cases of eosinophilic pustular folliculitis in a 45-year-old man and a 25-year-old woman. After their conditions failed to respond to oral and topical corticosteroids, minocycline, anti-allergic drugs, aspirin and several types of nonsteroidal anti-inflammatory drugs, good results were obtained with acemetacin.

Eosinophilic pustular folliculitis in an HIV-positive man: response to cetirizine

Eosinophilic pustular folliculitis is a rare condition which is being increasingly reported in HIV-positive patients. Many therapies have been used to treat this condition. We report the first successful use of the H1 antihistamine cetirizine to treat the condition and postulate that the specific antieosinophilic action of this drug may explain the beneficial clinical effect seen in our patient.

Eosinophilic pustular folliculitis (Ofuji disease) in childhood: a review of four cases

Four children under 2 years of age were treated at our hospital in the last three years with a recurrent vesiculopustular eruption of the scalp, variably extending to the face and limbs. All cases followed a cyclical pattern. Three of the children had a moderate response to topical steroids, and one went into remission after a two-month course of erythromycin. Ethnic origin may be an important predisposing factor. Histologically, all patients showed a moderate mixed inflammatory infiltrate with numerous eosinophils centered around hair follicles. Peripheral white blood cell count showing leukocytosis with eosinophilia was observed in those cases measured, but no consistent immunologic abnormalities could be identified.

Eosinophilic pustular folliculitis: fungal folliculitis?

Eosinophilic pustular folliculitis is a rare condition with no known cause. However, a fungal cause is suggested by (1) tinea-like annular lesions, (2) initial clinical consideration of fungal folliculitis in many reported cases, (3) an association with the acquired immunodeficiency syndrome, and (4) an association with scaly and vesiculopustular lesions of palms and soles. We report a case histologically identical to eosinophilic pustular folliculitis but in which hyphal fungal organisms were demonstrated in one of the involved hair follicles.

Sterile eosinophilic pustulosis in dog and man: comparative aspects

Sterile eosinophilic pustulosis is a rare dermatosis of dogs and humans. The clinicopathologic aspects of the disorder are similar in both species. In both the disease is characterized by a moderately generalized, pruritic, sterile, follicular and nonfollicular papulopustular dermatitis. Blood and tissue eosinophilia are usually present. Response to systemic glucocorticoids is better in dogs, probably because of the larger doses that can be used. The disorder is chronic and recurrent in both species.

Eosinophilic pustular folliculitis in patients with acquired immunodeficiency syndrome. Report of three cases

Eosinophilic pustular folliculitis is a rare disease. Highly unusual is its occurrence in three patients with acquired immunodeficiency syndrome (AIDS), described herein. This association may be the result of immunologic aberrations that are described in AIDS and may represent an abnormal reaction to skin saprophytes and dermatophytes.

Tinea infection histologically simulating eosinophilic pustular folliculitis

A biopsy taken from an annular eruption on the thigh of an infant boy showed features of Ofuji's eosinophilic pustular folliculitis, yet fungal hyphae were demonstrated in the lesion. This case is reported to illustrate that tinea infection can stimulate eosinophilic pustular folliculitis histologically.

Eosinophilic pustular folliculitis

Sterile, pruritic papules and papulopustules that formed annular rings developed on the back of a 58-year-old woman. The individual lesions evidenced peripheral extension with central clearing and were characterized by exacerbations and partial remissions. The general health of the patient was good. Laboratory determinations showed moderate peripheral blood eosinophilia. Spongiosis with eosinophilic exocytosis, often localized to the hair follicles, was found on examination of histologic specimens. These findings led to a diagnosis of eosinophilic pustular folliculitis, a disease of unknown cause that has rarely been reported in the North American literature.

Eosinophilic pustular folliculitis

We present the case of an American adult patient with eosinophilic pustular folliculitis. The majority of previously reported patients have been Japanese. Eosinophilic pustular folliculitis is a rare condition characterized by recurrent, peripherally expanding, sterile papulopustules and plaques. Hair-bearing areas such as the face, chest, back, and extensor surfaces of the upper arms are usually involved, although palms and soles can be affected as well. Histologic examination shows subcorneal and intrafollicular abscesses and spongiosis of the outer root sheath. The eosinophil is a prominent infiltrating cell, although mononuclear cells and neutrophils may also be seen. There is often a dense perivascular infiltrate of eosinophils in the dermis. Our patient was unusual in that he did not respond to multiple therapeutic regimens.

Eosinophilic pustular folliculitis

Eosinophilic pustular folliculitis was first described by Ofuji et al in 1970. It is characterized by pruritic circinate plaques that are studded with follicular papules and pustules. Lesions are located chiefly on the face, trunk, and arms. Biopsies of lesions demonstrate an infiltrate of eosinophils and neutrophils within hair follicles, dermis, and epidermis. Peripheral leukocytosis and eosinophilia are common.

Eosinophilic pustular folliculitis. Report of a European case

A case of eosinophilic pustular folliculitis (Ofuji) is presented. This long-lasting disease of unknown aetiology has hitherto been reported only from Japan. It is characterized by tinea-like slowly growing rings and by blood eosinophilia, The histological changes are epidermal infiltrations and abscesses of predominantly eosinophilic leukocytes, often localized to the follicles.