Eosinophilic pustular folliculitis: A proposal of diagnostic and therapeutic algorithms

Abstract

Eosinophilic pustular folliculitis (EPF) is a sterile inflammatory dermatosis of unknown etiology. In addition to classic EPF, which affects otherwise healthy individuals, an immunocompromised state can cause immunosuppressionassociated EPF (IS-EPF), which may be referred to dermatologists in inpatient services for assessments. Infancyassociated EPF (I-EPF) is the least characterized subtype, being observed mainly in non-Japanese infants. Diagnosis of EPF is challenging because its lesions mimic those of other common diseases, such as acne and dermatomycosis. Furthermore, there is no consensus regarding the treatment for each subtype of EPF. Here, we created procedure algorithms that facilitate the diagnosis and selection of therapeutic options on the basis of published work available in the public domain. Our diagnostic algorithm comprised a simple flowchart to direct physicians toward proper diagnosis. Recommended regimens were summarized in an easy-to-comprehend therapeutic algorithm for each subtype of EPF. These algorithms would facilitate the diagnostic and therapeutic procedure of EPF.

Eosinophilic dermatoses

“…In 2016, Nomura et al. proposed a classification of EPF subtypes , adding another entity: episodic eosinophilic dermatosis of the face.…”

“…Another variant is infantile EPF, which, unlike classic EPF, also affects the scalp. In 2016, Nomura et al proposed a classification of EPF subtypes [20], adding another entity: episodic eosinophilic dermatosis of the face.…”

Eosinophile Hautkrankheiten

“…Einen Versuch der Klassifikation der EPF unternahmen Nomura et al. Sie fügten als weitere Entität die episodische eosinophile Dermatose des Gesichtes hinzu .…”

“…Bezogen auf die „klassische“ von Ofuji beschriebene Entität der EPF existieren sehr viele Therapieberichte zu Indometacin, das von vielen Autoren als Mittel der ersten Wahl angesehen wird. Neben der systemischen Anwendung kommt auch eine lokale Anwendung in Betracht . Als Second‐Line‐Alternativen können eine UV‐Therapie, Cyclosporin A, Dapson, lokales Tacrolimus oder auch Doxycyclin erwogen werden.…”

Upregulation of IL‐36 cytokines in folliculitis and eosinophilic pustular folliculitis

“…Therefore, the overexpression of IL‐36s has been documented in various skin diseases such as allergic contact dermatitis, atopic dermatitis, mycosis fungoides, Sézary syndrome, autoimmune blistering diseases, hidradenitis suppurativa and acne . Eosinophilic pustular folliculitis (EPF) is a distinct clinical entity first described in 1965 by Ise and Ofuji as a variant of superficial pustular dermatosis . Histopathologically, EPF is characterised by an eosinophil‐dominant infiltrate within and around the pilosebaceous units, often accompanied by eosinophilic microabscess formation .…”