A Case Report of Necrotizing Eosinophilic Folliculitis Occurring After Rhus Ingestion

Necrotizing eosinophilic folliculitis is known as a rare variant of eosinophilic folliculitis (EF). It differs from classic EF because of its necrotizing ulcerative clinical course. We report a case of necrotizing eosinophilic folliculitis accompanied by pathergic phenomenon that may be the result of a delayed type hypersensitivity reaction occurring after Rhus consumption. Painful pyodermic plaques developed in a 48-year-old man, over a 5-day period, which was associated with facial edema. The lesions appeared 2 days after ingestion of Rhus. His face showed multiple painful pruritic papules that coalesced into crusted plaque accompanied by hemorrhagic eschars. At the periphery of the plaques, multiple erythematous papules and pustules were noticed. Prominent tissue eosinophilia was noticed from the skin biopsy samples. Also, there were areas of follicular mucinosis and eosinophilic folliculitis as well as hemorrhagic scale crust over the surface. Based on the clinical and histologic findings, the patient was diagnosed as necrotizing eosinophilic folliculitis occurring after Rhus ingestion. The lesions rapidly cleared after starting treatment with systemic steroid and dapsone. Clinicians should be aware that necrotizing eosinophilic folliculitis may occur after Rhus contact or consumption, in order to diagnose and treat patients promptly and reduce patient discomfort and skin scarring.