Eosinophilic pustular folliculitis: successful treatment with topical pimecrolimus

Abstract

Conflict of interest: there are no conflicts of interest. Eosinophilic pustular folliculitis (EPF) is a disorder of unknown aetiology, which is characterized by crops of pruritic follicular papulopustules in acne‐prone areas.1, 2 The increasing number of human immunodeficiency virus (HIV)‐associated EPF cases suggests that it may be a disorder of immune dysfunction.3 We report a case of EPF successfully treated with topical pimecrolimus. A 22‐year‐old man visited our department complaining of recurrent crops of pruritic eruptions on face, back and upper extremities for several years. Physical examination revealed follicular papulopustules on left cheek (Fig. 1a). White blood cell count was 6100/µL (3.9% eosinophils), and routine laboratory investigations, including HIV serology, found no abnormalities. Pustule culture was negative for microorganisms. Skin biopsy revealed destruction of hair follicles with massive infiltration of eosinophils, which confirmed the diagnosis of EPF (Fig. 1c). At first, topical corticosteroid was prescribed but it was found to be ineffective. Colchicine (0.5 mg twice a day) was then administered for 2 weeks but the patient still complained of pruritic eruptions as well as intolerable abdominal cramping and diarrhoea. Indomethacin was not prescribed because the patient had a history of gastritis. Based on a report demonstrating efficacy of topical tacrolimus in EPF,3 we decided to start topical pimecrolimus 1% cream. Significant improvement was observed after 1 week of application (Fig. 1b), and lesions completely resolved within 3 weeks. Only pimecrolimus was prescribed for 4 months, and intermittent eruptions were well controlled. No significant side‐effects were found to be related to the use of pimecrolimus cream.