Sean Klepper M.D.
Artur Zembowicz M.D....
Also known as: eosinophilic pusutular folliculitis
- Disease of unknown etiology
- Affects four different demographics:
- Adult Japanese men
- Infants and young children
- Patients with HIV
- Patients with an atopic diathesis
- Classic form (affecting adult Japanese men):
- Most common on the face, trunk and upper extremities
- Presents as erythematous follicular papules and pustules which coalesce to form polycyclic plaques with centripetal extension central clearing
- Often pruritic
- Postinflammatory hyperpigmentation is common.
- There is often a peripheral leukocytosis with eosinophilia.
- Pediatric variant:
- Also shows a male predominance; patients are most often less than one year of age.
- Most common on the scalp and forehead.
- Differs from the classic variant in that the lesions in that it normally lacks the polycyclic morphology and centripetal extension.
- HIV-associated variant:
- Seen in the setting of advanced AIDS (CD4 count <200)
- Severely pruritic
- Presents with follicular urticarial papules with rare pustulation and no polycyclic plaques
- The variant affecting patients with an atopic diathesis shows ulceration, follicular necrosis and eosinophilic vasculitis.
- Intra- and perifollicular inflammation rich in eosinophils
- Often spongiosis of the follicle and sebaceous lobules
- There are sometimes subcorneal eosinophilic pustules.
- Often a pervivascular and interstitial lymphocytic infiltrate within the reticular dermis
- The variant associated with an atopic diathesis shows the additional features of follicular necrosis and eosinophilic vasculitis.