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| Fig. 39.4 Eosinophilic folliculitis. Multiple pruritic, firm, urticaria-like pink papules are present on the face of this HIV-positive patient. |
HIV-associated eosinophilic folliculitis is a chronic, pruritic dermatosis of unknown etiology characterized by discrete, erythematous, follicular, urticarial papules on the head and neck, trunk, and proximal extremities (Fig. 39-4). Most cases occur in males, but the disease has been reported in females. Bacterial cultures are negative, and the eruption does not resolve with antistaphylococcal treatment. It is associated with peripheral eosinophilia, an elevated serum IgE level, and advanced HIV infection (CD4 counts lower than 250 cells/mm
3). Eosinophilic folliculitis is not specific for HIV infection, as it has rarely been described in association with hematologic malignancies.
Transverse histologic sections are superior to vertical sections in the diagnosis of this disease. Histopathologic findings include a perivascular and perifollicular mixed infiltrate with variable numbers of eosinophils and spongiosis of the follicular infundibulum or sebaceous gland with a mixed infiltrate. Treatment options include potent topical corticosteroids, antihistamines, ultraviolet B phototherapy, itraconazole, oral metronidazole, permethrin cream, and isotretinoin.
Piantanida EW, Turiansky GW, Kenner JR, et al: HIV-associated eosinophilic folliculitis: diagnosis by transverse histologic sections,
J Am Acad Dermatol 38:124–126, 1998.
Simpson-Dent SL, Fearfield LA, Staughton RCD: HIV-associated eosinophilic folliculitis: differential diagnosis and management,
Sex Transm Infect 75:291–293, 1999.
