Eosinophilic pustular folliculitis (EPF) in a patient with HIV infection
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Eosinophilic pustular folliculitis (EPF) in a patient with HIV infection T. Kanaki1 · E. Hadaschik1 · S. Esser1 · Stefanie Sammet1 Received: 25 June 2020 / Accepted: 28 September 2020 © The Author(s) 2020
Abstract Eosinophilic pustular folliculitis is a chronic, recurrent dermatosis, of unknown etiology, which is histologically characterized by folliculotropic inflammatory infiltrates with admixed eosinophils in the dermis. It has often presented with immunosuppression and especially with HIV-Infection. In the HAART-era, eosinophilic pustular folliculitis has become a rarity. It is often being misdiagnosed as acne vulgaris, rosacea, bacterial folliculitis, dermatomycosis and seborrheic dermatitis. The treatment of this disease may be difficult. A 51-year-old Ghanaian, female patient presented in our outpatient department of venereology in January 2020 with a recently diagnosed HIV infection, to continue her treatment. The patient had pruritic skin eruption on her face and upper buttock that had appeared 6 months prior to presentation in our department. Inspection revealed multiple disseminated papules and plaques on her face and on her back with postinflammatory hyperpigmentation. No scratch excoriations were noticed on the face of the patient (Figs. 1, 2). On the back, the patient had multiple excoriations revealing a moderate-to-severe pruritus. The patient was being treated until then for acne vulgaris with metronidazole gel and azelaic acid 15% gel and showed no improvement. The patient lives in Germany since June 2013. In November 2019, she was diagnosed with the HIV infection and since then was being treated with Emtricitabin 200 mg/ Tenofovir Alafenamid 25 mg once per day and Raltegravir 400 mg twice per day. Her CD4 ( +)-T-lymphocyte count was 101/µL (604–1188/µL), virus load was 1.5 million copies. Additional laboratory findings of the patient were the following: leucocyte count: 4, 90/nL (3, 6–9, 2/nL), blood eosinophilia 1% (2–4%), C-reactive protein 0.5 mg/ dL ( 40 years old In every age, depending on type
Rosacea Bacterial folliculitis Dermatomycosis Seborrheic dermatitis Cutaneous T-cell lymphoma Follicular mucinosis
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Variable depending on ethnicity
untreated HIV-positive patients with EPF is the initiation of combined antiretroviral therapy (HAART). Topical therapies include tacrolimus and steroids. UVB radiation can be used additionally. In case of persistence of the lesions topical ketoconazole, metronidazole, permethrin and systemic treatments, such as indomethacin, tetracyclines and itraconazole are further described as treatment options [7]. Our patient is being treated locally with Pimecrolimus 1% cream in combination with HAART. Under therapy had the patient a minimal improvement of the disease. With the recovery of the immune system and the reduction of the virus load, a significant improvement of the skin condition is expected.
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