Eosinophilic pustular folliculitis of infancy suppressed with cetirizine

Abstract

Eosinophilic pustular folliculitis of infancy is a rare inflammatory disease characterized by recurrent, itchy sterile pustules mainly located on the scalp. Topical agents are mostly effective to suppress the symptoms in the majority of cases. However, systemic agents that are safe for long-term use are required for patients with widespread or resistant lesions. We present a case with eosinophilic pustular folliculitis of infancy whose disease was suppressed with cetirizine but recurred after ceasing the drug. Pediatric DermatologyODYAKMAZ DEMIRSOY Et Al. pustular folliculitis in the literature responsive to systemic antihistamines (cimetidine, cetirizine, and hydroxyzine). [4][5][6] The effect of cetirizine in EPFI is probably due to the antieosinophilic action provided by inhibition of eosinophil migration rather than its well-known mechanism, H 1 receptor blockage. 6Our patient was free of lesions after 2 weeks of systemic cetirizine treatment. As he had a history of frequent flares, cetirizine was continued, and this resulted with remission of the disease for the following 2 months. EPFI is usually a self-limited disease, and most of the patients experience spontaneous resolution by the age of 3 years. 1 Thus, recovery of our patient's disease could possibly be attributed to resolution of the disease at his age rather than the effect of cetirizine. Due to this possibility, we ceased cetirizine after 2 months of treatment, but new itchy lesions appeared on the third untreated day. Achieving remission again by restarting cetirizine at the same dosage strongly supports effect of cetirizine in EPFI.Switching from daily to every other day dosage did not change this effect for the following 8 weeks.In conclusion, cetirizine may be considered in the first-line treatment, especially against EPFI with frequent attacks. Keywords cetirizine, eosinophilic pustular folliculitis, infancy O RCI D Evren Odyakmaz Demirsoy https://orcid.

Use of H-1 Antihistamine in Dermatology: More than Itch and Urticaria Control: A Systematic Review

“…Skin biopsies of eosinophilic pustular folliculitis (EPF) find eosinophils around hair follicles. In addition to topical steroids, antihistamines such as cetirizine [ 47 ], hydroxyzine [ 48 ], and astemizole [ 49 ] have been utilized in the treatment of EPF, including several pediatric cases [ 48 , 50 ]. Inhibitory effect of antihistamines on eosinophil migration is believed to be responsible for the clinical improvement [ 51 ].…”

Role of food allergy in the etiology of infantile eosinophilic pustular folliculitis

“…Although there are case reports of using different treatments such as indomethacin, tacrolimus, antibiotics, systemic corticosteroids, phototherapy, cyclosporine, and dapsone, 1,6 we have avoided using them for the infant. Instead, we preferred the antihistamines because of the safety and the successful results in some case reports 7,8 . Then, cetirizine 2.5 mg/day added to the treatment process.…”