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 successfully treated with sequential therapy of interferon-γ and ciclosporin

“…As assessed by semiquantitative reverse transcriptase PCR, disturbance of Th2 cell function by IFN-c reduced the production of IL-5, an eosinophilia-associated Th2 cytokine, resulting in improvement of EPF. 4 In the present study, we demonstrated that administration of IFN-c decreased serum IL-5, conforming the previous observation. 4 As the frequency of CCR4+ CD4+ Th2 cells was not affected by IFN-c, this Th1 cytokine perturbed Th2 cell function without reducing Th2 cell number.…”

“…4 In the present study, we demonstrated that administration of IFN-c decreased serum IL-5, conforming the previous observation. 4 As the frequency of CCR4+ CD4+ Th2 cells was not affected by IFN-c, this Th1 cytokine perturbed Th2 cell function without reducing Th2 cell number.…”

“…The critical issue of the previous IFN-c regimen was the drastic recurrence of the condition after its cessation. 4 In this respect, we suggest that sequential ciclosporin therapy is beneficial for successful discontinuation of IFN-c without EPF recurrence.…”

Eosinophilic Pustular Folliculitis in Children after Stem Cell Transplantation: An Eruption Distinct from Graft‐Versus‐Host Disease

“…The pathogenesis of EPF in general is not fully understood. A Th2-weighted immune response seems to be important, and accordingly, treatment with IFN-c was reported to be beneficial (9). Furthermore, prostaglandins have been implicated in sebocyte production of eotaxin, a key factor in eosinophil chemotaxis, which may explain the efficacy of nonsteroidal antiinflammatory drugs (NSAIDs) in treating EPF (10).…”

Systemic Administration of Hochu‐ekki‐to (Bu‐Zhong‐Yi‐Qi‐Tang), a Japanese‐Chinese Herbal Medicine, Maintains Interferon‐γ Production by Peripheral Blood Mononuclear Cells in Patients with Mycosis Fungoides

“…Based on distinct patterns of cytokine secretion, T-helper cell populations are categorized into Thl and Th2 cell subsets (6), which counter-regulate each other's biological behavior. The administration of Thl cytokines such as IFN-y thus improves cutaneous disorders in which Th2 cells are pathogenic by inhibiting Th2 cells and activating Thl cells (7)(8)(9). Although Thl type Sezary syndrome exists (10), the vast majority ofreported cases of cutaneous T-cell lymphoma (CTCL) have Th2 type lymphoma cells (11).…”