The histopathology of folliculitis in HIV-infected patients

Cutaneous disease referable to human immunodeficiency virus (HIV) infection has become less common with the advent of widespread administration of antiretroviral medications, particularly the protease inhibitors. Pruritic eruptions that fall into the general categorization of folliculitis continue to be problematic.

In this report, we describe 33 skin biopsy samples prospectively obtained of follicular papules and pustules from 33 HIV-infected individuals with the clinical diagnosis of HIV-related folliculitis.

The histopathologic findings were stratified as follows: (i) acute folliculitis with bacteria and/or yeast (n = 9); (ii) lymphocytic perifolliculitis (n = 7); (iii) eosinophilic folliculitis (n = 5); (iv) perifolliculitis with mixed inflammation (n = 11); (v) follicular rupture with predominant granulomatous inflammation (n = 1). Demodex organisms were found in 10 specimens scattered among these categories.

The histopathology of folliculitis in HIV-infected patients is protean. No single factor could be identified as the cause, making targeted antibacterial or antifungal therapy unlikely to be successful across a wide range of patients.