Classic Eosinophilic Pustular Folliculitis in an Immunocompetent Patient with Syphilis: Are They Related?

Abstract

Eosinophilic pustular folliculitis (EPF) is a rare, chronic, non-infectious inflammatory skin disease. Although the pathogenesis of EPF is unknown, eosinophilic pustular folliculitis may be associated with human immunodeficiency virus (HIV) infection, malignancies or syphilis. Here, we report the first case of EPF associated with syphilis, indicating that syphilis and EPF are correlated with T-helper type 2 immune responses. A 48-year-old man gradually developed erythema and pustules on the face, neck. Physical examination revealed multiple infiltrative red patches and plaques on the face, neck with tiny pustules. Skin biopsy results revealed that the dermal follicular sebaceous gland unit was infiltrated by a large number of neutrophils and eosinophils, forming eosinophilic microabscesses. Therefore, the patient was diagnosed with EPF associated with syphilis and received drug treatment. After the treatment, the pustules markedly decreased, leaving behind pigmentation. Furthermore, the patient is still being followed up.

A Case of Eosinophilic Pustular Folliculitis Misdiagnosed as Eczema

“…The infantile type mostly occurs in children under one year old, with a higher prevalence in male infants, and 70% of patients develop symptoms within six months after birth. 5 , 6 The etiology and pathogenesis of this disease are not yet fully understood. It has been reported that EPF can be associated with human immunodeficiency virus, autoimmune diseases, and autologous peripheral blood stem cell and allogeneic bone marrow stem cell transplantation.…”

The Role of Reflectance Confocal Microscopy in the Diagnosis and Therapeutic Evaluation of Rare Disease Eosinophilic Pustular Folliculitis

“…The disease typically follows a chronic course and is more prevalent among young men. 2 The hallmark of a typical skin lesion is a whirlpool or creeping red patch, which eventually evolves into red, pinhead-sized follicular papules and pustules. 3 These lesions may be clustered or arranged circularly, displaying clear boundaries.…”