Eosinophilic pustular folliculitis: A published work-based comprehensive analysis of therapeutic responsiveness.

Eosinophilic pustular folliculitis (EPF) is a non-infectious inflammatory dermatosis of unknown etiology that principally affects the hair follicles. There are three variants of EPF: (i) classic EPF; (ii) immunosuppression-associated EPF, which is subdivided into HIV-associated (IS/HIV) and non-HIV-associated (IS/non-HIV); and (iii) infancy-associated EPF. Oral indomethacin is efficacious, especially for classic EPF. No comprehensive information on the efficacies of other medical management regimens is currently available. In this study, we surveyed regimens for EPF that were described in articles published between 1965 and 2013. In total, there were 1171 regimens; 874, 137, 45 and 115 of which were applied to classic, IS/HIV, IS/non-HIV and infancy-associated EPF, respectively. Classic EPF was preferentially treated with oral indomethacin with efficacy of 84% whereas topical steroids were preferred for IS/HIV, IS/non-HIV and infancy-associated EPF with efficacy of 47%, 73% and 82%, respectively. Other regimens such as oral Sairei-to (a Chinese-Japanese herbal medicine), diaminodiphenyl sulfone, cyclosporin and topical tacrolimus were effective for indomethacin-resistant cases. Although the preclusion of direct comparison among cases was one limitation, this study provides a dataset that is applicable to the construction of therapeutic algorithms for EPF.

Eosinophilic pustular folliculitis: the transition in sex differences and interracial characteristics between 1965 and 2013.

Eosinophilic pustular folliculitis (EPF) is characterized by a non-infectious infiltration of eosinophils in the hair follicles. It has three variants: (i) classic EPF; (ii) immunosuppression-associated EPF, which herein is subdivided into HIV-associated (IS/HIV) and non-HIV-associated (IS/non-HIV); and (iii) infancy-associated EPF (I-EPF). The rarity of EPF has hindered our understanding of this entity. To examine the characteristics of EPF, with respect to age, sex, race, and chronology, published in case reports to date, we queried PubMed using the following terms: ("eosinophilic pustular folliculitis" [All Fields] OR "eosinophilic folliculitis" [All Fields]) AND ("1965/1/1" [PDAT]: "2013/12/31" [PDAT]). Additional Japanese cases were collected from Igaku Chuo Zasshi through Ichushi-Web, JDream III, and secondhand quotations from domestic periodicals published in Japan. Proceedings were excluded. The PubMed search produced 275 citations containing 358 cases of EPF (224 men, 132 women, and two of unspecified sex); these cases involved classic EPF (101 Japanese and 81 non-Japanese), IS/HIV (4 Japanese and 85 non-Japanese), IS/non-HIV (4 Japanese and 20 non-Japanese), and I-EPF (4 Japanese and 59 non-Japanese). Ichushi generated an additional 148 citations containing 207 cases of Japanese (148 men and 59 women), which included cases of classic EPF (181 cases), IS/HIV (14 cases), IS/non-HIV (9 cases), and I-EPF (3 cases). There was no sex difference in the classic EPF cases reported between 2003 and 2013, whereas IS/HIV, IS/non-HIV, and I-EPF were predominated by men. There is room for reconsideration of sex differences, particularly with regard to classic EPF. The rarity and specificity of I-EPF in Japan may reflect a state of uncertainty about this entity.

Eosinophilic pustular folliculitis: a review of the Japanese published works.

Eosinophilic pustular folliculitis (EPF), also known as Ofuji's disease, is an inflammatory dermatosis that was first described in Japan in 1970. More than 300 cases have been reported so far, and 113 Japanese cases have been reported in Japan since 1980. To comprehend the characteristics of Japanese EPF cases, we classified these cases into three types: classic, immunosuppression-associated (IS-EPF), and infancy-associated (I-EPF). Trends in age of onset and in distribution and characterization of eruptions differed between the types. We found 91 cases of classic EPF (mean age, 39.7 years), consisting of 66 males (73%) and 25 females (27%), in most of which eruptions primarily affected the face; 18 cases of IS-EPF (44.2 years), consisting of 15 males (83%) and three females (17%), in which eruptions affected the face less predominantly; and four cases of I-EPF (7.0 years), consisting of two males (50%) and two females (50%), primarily affecting the scalp. The number of IS-EPF cases has increased since the late 1990s, reflecting the increasing number of HIV-positive patients in Japan. Systemic non-steroidal anti-inflammatory drugs were effective in more than 70% of cases. Dimethyl diphenyl sulfone, antibiotics including minocycline, psoralen plus ultraviolet A therapy and ultraviolet B treatments worked in some cases. Topical steroids and tacrolimus were also effective in some cases of EPF, while topical indomethacin was less effective.

Foliculitis pustulosa eosinofílica: Enfermedad de Ofuji / Eosinophilic pustular folliculitis: Ofuji's disease

Presentamos un caso de la denominada foliculitis pustulosa eosinofílica o enfermedad de Ofuji, sin eosinofilia periférica ni inmunosupresión asociada. El cuadro respondió inicialmente bien a la dapsona, pero debido a un aumento de enzimas hepáticas y bilirrubina se rotó a terapia tópica con clobetasol y pimecrolimus, con buena respuesta. Efectuamos una revisión del cuadro enfatizando que el mismo constituye una inflamación del epitelio infundibular y no folicular constituyendo un patrón de respuesta a múltiples causas, algunas o la mayoría no bien conocidas.

A case of the so called eosinophilic pustular folliculitis or Ofuji´s disease, without blood eosinophilia nor immunosuppression is reported. The patient responded at first well to Dapsone, but an increase of the hepatic enzymes and bilirubin was detected and only topical therapy with clobetazol and pimecrolimus was carried out with a good response. A revision of the disease with emphasis in the concept of infundibulitis rather than folliculitis was made. The eosinophilic pustular folliculitis is a pattern of response to multifactorial, mostly unknown, causes and not a single disease.

A review of 55 cases of cutaneous lymphoid hyperplasia: reassessment of the histopathologic findings leading to reclassification of 4 lesions as cutaneous marginal zone lymphoma and 19 as pseudolymphomatous folliculitis.

To clarify the confusion surrounding the diagnosis of cutaneous lymphoid hyperplasia (CLH) that was formerly described as lymphadenosis benigna cutis, lymphocytoma cutis, or lymphocytic infiltration of Jessner and to assess whether newly recognized diagnoses, such as cutaneous marginal zone lymphoma and pseudolymphomatous folliculitis (PLF), may have been overlooked, we reexamined 55 Japanese cases of nonepidermotropic lymphoproliferative disorder that had previously been diagnosed as "cutaneous pseudolymphoma." In all these cases, the immunohistochemical expressions of CD1a, CD3, CD4, CD8, CD20, CD21, CD30, CD43, CD56, CD68, CD79a, kappa and lambda chains, S-100 protein, and latent membrane protein were assessed. In addition, in 13 cases the gene rearrangement of the immunoglobulin heavy chain was investigated using a polymerase chain reaction method. As a result of these investigations, we have identified 4 cases of cutaneous marginal zone lymphoma, 19 cases of PLF, 1 case of diffuse large B-cell lymphoma, and 2 cases of solitary nonepidermotropic pseudo-T-cell lymphoma, with the remaining 29 cases being CLH. Cutaneous marginal zone lymphoma, which represented 7.3% of the total, was distinguished from CLH by the presence of patchy or diffuse proliferation of centrocyte-like cells, plasma cells at the periphery of the lymphocytic infiltration, monotypic restriction of the light chains, and gene rearrangement of the immunoglobulin heavy chain. Pseudolymphomatous folliculitis was identified by the presence of activated pilosebaceous units with abundant CD1a-and S-100 protein-positive T-cell-activated dendritic cells. Of the cases that were reassessed, 34.5% were PLF.

Treatment of pseudofolliculitis barbae using the long-pulse Nd:YAG laser on skin types V and VI.

BACKGROUND: Pseudofolliculitis barbae (PFB) is a foreign body inflammatory condition that is caused by in-grown hairs of the face and body. An effective treatment to alleviate this condition without the risk of side effects has yet to be found. OBJECTIVE: The objective of this study was to evaluate the Lyra 1064-nm long-pulse ND:YAG laser in the treatment of PFB on skin types V and VI. METHODS: Twenty subjects (12 males and 8 females) were given two treatments approximately 3 to 4 weeks apart and were assessed by objective papule/pustule and hair counts at 1, 2, and 3 months after final treatment. Laser treatments with the Lyra Nd:YAG laser were applied onto 2x2-cm regions on the upper and lower mandible and neck regions. Contralateral controls were used to assess overall effectiveness. Subjective evaluations were also obtained from both subjects and investigators. Assessments of any abnormal side effects caused by laser treatment, including dyspigmentation and/or scarring, were also evaluated. RESULTS: A reduction in the quantity of papules/pustules and hairs when compared with baseline data was statistically significant for treatment of PFB in the mandibular and neck regions at the 1-, 2-, and 3-month follow-up evaluations. Subject evaluations ranged from satisfied to very satisfied. Side effects included transient hyperpigmentation, transient hypopigmentation, mild erythema, and itching. CONCLUSIONS: The use of the 1064-nm long-pulse Nd:YAG laser for the treatment and management of PFB on skin types V and VI is both safe and effective, with positive results lasting for up for to 3 months after two treatments.