Eosinophilic folliculitis (EF) is an itchy rash with an unknown cause which is most common among individuals with HIV, though it can occur in normal individuals where it is known by the eponym Ofuji disease. EF consists of itchy red bumps (papules) centered on hair follicles and typically found on the upper body, sparing the abdomen and legs. The name eosinophilic folliculitis refers to the predominant immune cells associated with the disease (eosinophils) and the involvement of the hair follicles.
Eosinophilic folliculitis associated with HIV infection typically affects individuals with advanced HIV and low T helper cell
counts. It affects both men and women as well as children with HIV and is found throughout the world.
EF may also affect individuals with hematologic disease such as leukemia and lymphoma. It may also affect otherwise normal infants in a self-limited form. Finally, normal individuals can also develop EF — this is more common in Japan.
The cause of EF is unknown. A variety of microorganisms
have been implicated, including the mite Demodex
, the yeast Pityrosporum
, and bacteria
. An autoimmune
process has also been investigated.
Eosinophilic folliculitis may be suspected clinically when an individual with HIV exhibits the classic symptoms. The diagnosis can be supported by the finding of eosinophilia
but a skin biopsy
is necessary to establish it. Skin biopsies reveal lymphocytic
and eosinophilic inflammation
around the hair follicles.
Treatment of eosinophilic folliculitis in people with HIV typically begins with the initiation of Highly Active Anti-Retroviral Therapy
in order to help reconstitute the immune system. Direct treatment of the EF itself focuses on decreasing the inflammation and itching. Topical corticosteroids
and oral antihistamines
can alleviate the itching and decrease the size and number of lesions. Treatment with the antifungal drug itraconazole
, the antibiotic metronidazole
, and the anti-mite drug permethrin
may lead to some improvement of symptoms. Other therapies include PUVA
, topical tacrolimus
, and isotretinoin