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Eosinophilic pustular folliculitis in infancy: report of two new cases
M Larralde1, S Morales, A Santos Muñoz
1Department of Pediatric Dermatology, Ramos Mejía Hospital, Buenos Aires, Argentina.
Abstract:
Eosinophilic pustular folliculitis (EPF) is a cutaneous inflammatory follicular disorder of unknown etiology. The diagnosis is made on the basis of clinical and histopathologic features. We describe two patients who had recurrent episodes of pruritic follicular papular and pustular lesions on the face, extremities, and trunk. The eruptions lasted for 1 month with intermittent remissions. Laboratory tests disclosed no infectious or parasitic etiology in patient 2. In patient 1 we isolated methicillin-resistant Staphylococcus aureus in a blood culture. He had sepsis with lung and liver involvement. EPF is a self-limited dermatosis. On occasion, skin lesions may become superinfected, resulting in localized pyoderma or rarely systemic infection (sepsis). Histologically both of our patients showed a moderate mixed inflammatory infiltrate with numerous eosinophils centered around hair follicles. Their lesions responded well to topical corticosteroids.
Insights
Eosinophilic pustular folliculitis (EPF) presents as itchy, pustular lesions. While often self-limiting, it can lead to severe infections like sepsis, but responds to topical corticosteroids.
Area of Science:
- Dermatology
- Immunology
- Infectious Diseases
Background:
- Eosinophilic pustular folliculitis (EPF) is a rare inflammatory skin condition affecting hair follicles.
- Its exact cause is unknown, and diagnosis relies on clinical and histopathological examination.
- EPF can present with recurrent, itchy, papular, and pustular lesions on the face, trunk, and extremities.
Observation:
- Two patients experienced recurrent EPF episodes lasting approximately one month with intermittent remissions.
- Patient 1 developed sepsis with lung and liver involvement due to methicillin-resistant Staphylococcus aureus (MRSA) bacteremia.
- Patient 2 had no identifiable infectious or parasitic cause for their EPF.
Findings:
- Histological examination revealed a mixed inflammatory infiltrate rich in eosinophils around the hair follicles in both patients.
- Despite the potential for superinfection, as seen in Patient 1, EPF is generally considered a self-limited dermatosis.
- Both patients showed significant improvement with topical corticosteroid treatment.
Implications:
- This case series highlights the potential for severe complications, including sepsis, in patients with Eosinophilic pustular folliculitis.
- Early diagnosis and management are crucial, considering both inflammatory and infectious components.
- Topical corticosteroids remain an effective treatment modality for managing EPF symptoms.