Eosinophilic pustular folliculitis effectively treated with recombinant interferon-γ: suppression of mRNA expression of interleukin 5 in peripheral blood mononuclear cells

Abstract

Eosinophilic pustular folliculitis (EPF) is characterized clinically by pruritic grouped follicular papules and pustules on the trunk, limbs, and face, and, histologically, by follicular infiltration with eosinophils. The blood eosinophil count is elevated in most patients. Oral minocycline, nonsteroidal anti-inflammatory drugs, diaminodiphenylsulphone, and corticosteroids may induce remission. We report two Japanese men with EPF who responded poorly to the usual therapy. Intravenous injections of recombinant interferon-gamma (rIFN-gamma), 5 x 10(5) to 2 x 10(6) Japan Reference Unit (JRU) (1 JRU roughly corresponds to 4 NIH units) daily for 7 days, cleared the skin lesions and returned the peripheral eosinophil counts to normal in both patients. However, the lesions recurred 2-3 days after rIFN-gamma was stopped. Both patients have received intravenous rIFN-gamma once or twice a week for nearly 1 year without systemic side-effects. Reverse transcriptase-polymerase chain reaction revealed a decreased expression of interleukin 5 (IL-5) mRNA in peripheral mononuclear cells after the rIFN-gamma therapy. rIFN-gamma may become the treatment of choice in recalcitrant EPF, although further studies are needed. It may work by interfering with the immunological function of type 2 T-helper cells, including IL-5 production responsible for the growth and differentiation of eosinophils.

Eosinophilic pustular folliculitis (Ofuji's disease) in Singapore: A review of 23 adult cases

“…This similar combination has been reported to be successful in a previous case report. This observation further supports the hypothesis that EPF is a result of underlying immune dysregulation 14,15,19,20 rather than secondary to an infective process. 4 It is interesting to note that, apart from indomethacin, controlled-release ketoprofen was used in three of our patients with favourable results.…”

Eosinophilic pustular folliculitis successfully treated with sequential therapy of interferon-γ and ciclosporin

“…4 In the present study, we demonstrated that administration of IFN-c decreased serum IL-5, conforming the previous observation. An aberrant Th2-type immune response to a follicular antigen appears relevant to the pathogenesis of EPF.…”

PGD2 induces eotaxin-3 via PPARγ from sebocytes: A possible pathogenesis of eosinophilic pustular folliculitis

“…4 An immunohistochemical study has demonstrated the expression of intercellular adhesion molecules for inflammatory cells including eosinophils around hair follicles. 5 Other studies have reported that IL-5 level, which induces proliferation and differentiation of eosinophils, is elevated in the blood and skin lesions of patients with EPF, but it can be decreased by treatment with IFN-g. 6,7 Three members of the eotaxin family-eotaxin-1/CCL11, eotaxin-2/CCL24, and eotaxin-3/CCL26-are known to promote the growth and recruitment of eosinophils and skin inflammation. 8 T H 2 cytokines, such as IL-4, -5, and -13, enhance the production of eotaxins by skin component cells, such as lymphocytes, macrophages, endothelial cells, fibroblasts, and keratinocytes.…”