Eosinophilic Folliculitis Research Articles

Dermatological immune restoration syndrome: does it exist?

Dermatological conditions are often an early clue to HIV infection and are common. As the disease progresses patients develop a dominant Th-2 immunological response that may facilitate the development of a number of skin conditions. With antiretroviral therapy the Th-1 response is restored and some skin problems regress. But, paradoxically, some cutaneous conditions may worsen, such as herpes zoster, mucocutaneous herpes, eosinophilic folliculitis and mycobacterial infections. This may be because immune restoration of a host's immunity causes recognition of silent or latent infection and results in development of the condition.

Idiopathic linear pustular acantholytic dermatosis in a young Brittany Spaniel dog

A unilateral, linear, papular-pustular dermatosis is described in a young Brittany Spaniel dog. The dermatosis appeared to follow Blaschko's lines and extended from the left inguinal region to the medial aspect of the left metatarsal area. The predominant histological finding was an eosinophilic and neutrophilic pustular mural folliculitis with prominent acantholysis of infundibular epithelium. There was a rapid and long-lasting (> 15 months) resolution after oral administration of methylprednisolone (1.6 mg kg(-1)).

Role of Th2 cytokines, RANTES and eotaxin in AIDS-associated eosinophilic folliculitis.

The pathogenesis of AIDS-associated eosinophilic folliculitis is still unknown. The expression of chemokines and Th2-type cytokines is increased in other conditions associated with tissue eosinophilia and in allergic reactions. We evaluated the mRNA expression by reverse transcriptase polymerase chain reaction of two Th2 cytokines (interleukin-4 and interleukin-5) and of two chemokines (RANTES and eotaxin) in the skin of 6 patients with AIDS-associated eosinophilic folliculitis; the tissue localization of eotaxin was shown by immunohistochemistry. We demonstrated the increased expression of interleukin-4, interleukin-5, RANTES and eotaxin in lesional skin of the patients compared to normal skin of HIV+ individuals. We concluded that a Th2 pattern is present in AIDS-associated eosinophilic folliculitis. The cytokine milieu in this disease may favour a Th2 immune response to an unknown antigen, whereby RANTES and eotaxin act in synergy with interleukin-4 and interleukin-5 to mediate tissue inflammation.

Foliculitis pustulosa eosinofílica (enfermedad de Ofuji): respuesta al interferón alfa 2b

Abstract—Eosinophilic pustular folliculitis 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 mainly within the infundibula and the sebaceous glands. Peripheral leukocytosis and eosinophilia are common.We describe the case of a 46-year-old man who consulted because of the appearance of erythematous pustular, intensely itching, lesions on the arms, trunk and face. The blood count revealed a differential cell count of 21% eosinophils. Histopathologic examination of several biopsy specimens showed the presence of abundant follicular inflammatory infiltrate, with numerous eosinophils, specially within the sebaceous glands. We were not able to demonstrate any associated disease. After three years of resistance to numerous therapy regimens, treatment with interferon alpha 2b led the disease up to remission.Eosinophilic pustular folliculitis is a dermatosis of unknown etiology. Although it has been reported in adult immunocompetent healthy individuals, it can be associated with haematological malignancies. On the basis of our findings, we propose that this case should be classified as the classical idiopathic disease first described by Ofuji.

A Case of Eosinophilic Folliculitis after Allogenic Bone Marrow Transplantatino in Acute Myelogenous Leukemia

A Case of Eosinophilic Folliculitis after Allogenic Bone Marrow Transplantatino in Acute Myelogenous Leukemia

Cytokine expression patterns distinguish HIV associated skin diseases.

AIDS is known to cause a shift of cytokines in the periphery. However, predominant cytokines in skin of patients with HIV-associated skin diseases have not been clearly defined. We hypothesized that there are distinct cytokine profiles that distinguish among the different clinical manifestations of AIDS-related skin diseases. To test this hypothesis, lesional and non-lesional skin was biopsied from 53 HIV+ patients with Kaposi's sarcoma (KS), psoriasis, and pruritus due to eosinophilic folliculitis, and from HIV negative controls with psoriasis or KS prior to therapy. Immunohistochemistry was performed with antibodies to tumor necrosis factor (TNF)-alpha, interleukin (IL)-10, interferon (IFN)-gamma, and interferon-inducible protein (IP)-10. HIV positive individuals included 10 with psoriasis, 14 with pruritus, and 15 with Kaposi's sarcoma. HIV negative controls included 12 with psoriasis and two with KS. Semi-quantitative analysis of cytokine staining was confirmed by optical density using a digital imaging system on four representative skin sections from each disease. Optical density analyses were conducted using ANOVA and t-tests. We found that epidermis overlying HIV+ Kaposi's sarcoma was hyperproliferative and was highest in IP-10, IFN-gamma, and IL-10 (P=0.0001). HIV+ pruritus was significantly highest in TNF-alpha (P=0.0001) staining. HIV+ psoriasis represented an intermediate state for all four cytokines. Normal skin adjacent to lesions showed the same relative patterns, with lower intensities. Skin diseases seen frequently in the setting of HIV and immunodeficiency have relatively distinct levels and patterns of cytokine expression that may reflect immune dysfunction, reactivity to HIV and to opportunistic infections.

Necrotizing eosinophilic folliculitis as a manifestation of the atopic diathesis.

Eosinophilic folliculitis (EF) is an idiopathic eruption of sterile pustules and papules involving the trunk, face, and extremities, associated in many cases with human immunodeficiency virus (HIV) infection. The classic histopathology is one of follicular-based, eosinophilic spongiosis with variable microabscess formation. We describe nine HIV-negative patients who manifested a novel form of pustular EF in the setting of atopy. Paraffin sections of skin biopsies from ten patients, stained with hematoxylin and eosin and special preparations to evaluate for microbial pathogens, were examined. Detailed clinical histories and serologic studies were obtained. Among the clinical presentations in seven men, two women, and one girl (age range, 11-62 years) were ulcerative and/or nodular plaques mainly on the face and/or extremities, sometimes in an annular configuration. The clinical considerations included deep mycotic infection, ulcerative herpes, systemic vasculitis, Mucha Haberman disease, and pyoderma gangrenosum. All patients had a personal and/or family history of atopy. Co-existent medical illnesses included psoriasis, lupus erythematosus, and lymphoproliferative disease. One patient was on a calcium channel blocker, one on multiple antidepressants, and two on antihistamines, all of which are associated with immune dysregulation. All skin biopsies showed variable intra- follicular eosinophilic microabscesses, follicular necrosis, folliculocentric necrotizing eosinophilic vasculitis, marked degeneration of connective tissue fiber elements, and striking tissue eosinophilia, including flame figure formation and dermal eosinophilic abscesses. Apart from commensals, such as Pityrosporum and Demodex, microbial pathogens were not identified. The presentations differed from conventional EF by virtue of a strong association with atopy and by the presence of ulceration, nodule formation, follicular and dermal necrosis, and eosinophilic vasculitis. We propose the term "necrotizing eosinophilic folliculitis," and suggest that the basis of this novel form of EF is an unrepressed T-helper lymphocyte type 2 (Th2)-dominant response to various epicutaneous stimuli in patients with atopy, the prototypic immune dysregulatory state associated with a Th2-dominant cytokine milieu.

Mucocutaneous Manifestations in Japanese HIV-Positive Hemophiliacs

Background: Although various mucocutaneous manifestations have been reported in patients infected with HIV by sexual transmission or intravenous drug use, the prevalence and characteristics of skin disorders in HIV-positive hemophiliacs coinfected with hepatitits C virus (HCV) have rarely been described. Objective: The purpose of this study was to clarify the characteristics of skin disorders in HIV-positive hemophiliacs and to identify differences in comparison with other HIV-positive groups. Methods: A prospective study of the prevalence of mucocutaneous manifestations in 110 Japanese hemophiliacs (53 HIV-positive hemophiliacs including 24 AIDS and 57 HIV-negative hemophiliacs) was performed from July 1997 to July 1998. Result: None of the hemophiliacs developed Kaposi’s sarcoma or sexually transmitted skin diseases. Eosinophilic folliculitis was observed in 3 AIDS patients. The incidence of folliculitis, common warts, seborrheic dermatitis, generalized eczema, oral candidiasis and herpes zoster was higher in HIV-positive than in HIV-negative hemophiliacs (p < 0.05). Although anti-HCV antibody was positive in all HIV-positive hemophiliacs, HCV-related dermatoses such as lichen planus and porphyria cutanea tarda were not observed. Conclusion: Although Kaposi’s sarcoma and sexually transmitted skin diseases such as molluscum contagiosum, condyloma, and scabies are frequently associated with HIV, they were not found in the HIV-positive hemophiliacs in our study. HIV infection-related mucocutaneous manifestations are influenced not only by the presence of HIV but also by other factors such as the mode of transmission and sexual habit.

HIV associated eosinophilic folliculitis--differential diagnosis and management.

Eosinophilic folliculitis (EF) is a chronic, intensely pruritic condition of unknown pathogenesis that causes marked morbidity in those HIV patients whom it affects. There is a wide differential diagnosis of...

Itchy folliculitis and human immunodeficiency virus infection: clinicopathological and immunological features, pathogenesis and treatment.

The predominant itchy folliculitis associated with human immunodeficiency virus (HIV) infection appears to be an eosinophilic folliculitis (EF). This is characterized by lytic degeneration of sebaceous glands and an inflammatory infiltrate in which eosinophils and CD8+ T lymphocytes predominate. All patients have low CD4 counts and present late on in their HIV disease. Lesional distribution is mainly truncal, with a significant proportion also having facial involvement. Our prospective survey has shown that it is impossible to differentiate clinically between infective folliculitis and EF, and we recommend therefore that all cases are biopsied. We review the clinicopathological and immunological aspects of HIV-associated itchy folliculitis, in particular HIV-associated EF as well as current theories on pathogenesis and treatment. We suggest that HIV-associated EF is an autoimmune disease with the sebocyte or some constituent of sebum acting as the autoantigen.

Expression of neuronal nitric oxide synthase in dermal infiltrated eosinophils in eosinophilic pustular folliculitis.

Nitric oxide (NO) is produced by a wide variety of human cells and affects physiological and pathophysiological processes. In this study, we demonstrated for the first time that neuronal NO synthase (NOS) is expressed in eosinophils infiltrating into the dermis and follicular epidermis in eosinophilic pustular folliculitis (EPF). EPF is a cutaneous inflammatory follicular disorder first described in Japan. The clinical and histological features of EPF are characterized by erythematous papules, infiltration of numerous eosinophils, and a spongiotic appearance of the follicular epidermis, but the pathophysiology of EPF remains unclear. Our results suggest that NO produced from eosinophils plays an important part in the pathogenesis of EPF. Furthermore, we speculate that NOS inhibitors may be useful in the management of EPF.

Clinical and histological evaluation of immediate and delayed flea antigen intradermal skin test and flea bite sites in normal and flea-allergic cats.

Seven cats diagnosed as flea allergic by specific criteria and seven normal control cats were exposed to flea bites in a controlled manner and were given intradermal injections of 1:1000 w/v flea antigen. Subjective evaluation of gross lesions and documentation of histological changes at flea antigen intradermal skin test (IDST) and flea bite sites were performed at 15 min, 24 h and 48 h after IDST or flea exposure. Control cats did not develop an immediate gross reaction to either flea bites or the intradermal injection of flea antigen. All seven flea-allergic cats had an immediate gross reaction at the site of IDST with flea antigen; five of these cats also developed immediate gross reactions to flea bites. Three of seven flea-allergic cats developed a gross 24 h and/or 48 h delayed reaction at the flea antigen IDST sites. These three and one other cat had both an immediate and delayed gross reaction to flea bites. Histological examination of 15 min skin specimens from IDST and flea bite sites of flea-allergic cats were similar with a mild lymphocytic, histiocytic and mastocytic superficial perivascular dermatitis. Histological examination of 24 h and 48 h skin specimens from IDST and flea bite sites of flea-allergic cats showed that they were often indistinguishable. Histological features of IDST and flea bite sites of flea-allergic cats at 24 h consisted of a perivascular to diffuse predominately eosinophilic dermatitis and mural folliculitis with variable epidermal necrosis and ulceration.

A case of eosinophilic pustular folliculitis of Ofuji

A case of eosinophilic pustular folliculitis of Ofuji

Eosinophilic pustular folliculitis induced by carbamazepine

A 58-year-old man had taken a combination of acetaminophen and carbamazepine for headache and fever. Over the next 2 days, he experienced stomatitis and edematous erythema with papules and pustules on his face, neck, trunk, and extremities. This was diagnosed as a “drug eruption.” His stomatitis improved but his skin eruption persisted. Two months later, examination revealed edema of Eosinophilic pustular folliculitis induced by carbamazepine

Eosinophil chemokines in HIV-associated eosinophilic folliculitis

Eosinophil chemokines in HIV-associated eosinophilic folliculitis

Expression of eotaxin MRNA in aids-associated eosinophilic folliculitis

Expression of eotaxin MRNA in aids-associated eosinophilic folliculitis

Treatment of HIV-related eosinophilic folliculitis with itraconazole produces clinical remission and normalization of plasma eosinophils and IgE

Treatment of HIV-related eosinophilic folliculitis with itraconazole produces clinical remission and normalization of plasma eosinophils and IgE

HIV-related eosinophilic folliculitis is a TH2-dominant disease characterized by selective expression of eotaxin in dendritic cells and CCR3 in T-cells

HIV-related eosinophilic folliculitis is a TH2-dominant disease characterized by selective expression of eotaxin in dendritic cells and CCR3 in T-cells

皮膚科領域におけるインターフェロン（ＩＦＮ）‐γ療法

Interferon-γ is a multifunctional cytokine produced by Th1 cells. We have observed clinical efficacy of this cytokine in the treatment of Ki-1+ lymphoproliferative disorders, eosinophilic pustular folliculitis and chronic prurigo.

HIV-associated eosinophilic folliculitis: Diagnosis by transverse histologic sections

HIV-associated eosinophilic folliculitis: Diagnosis by transverse histologic sections