HIV‐Associated Eosinophilic Pustular Folliculitis: Successful Treatment of a Japanese Patient with UVB Phototherapy

Abstract

We report the successful treatment with ultraviolet B phototherapy of a patient with HIV-associated eosinophilic pustular folliculitis. We were able to observe the clinical and therapeutic course for about one year and three months. This 35-year-old homosexual Japanese man presented with disseminated, discrete, follicular, erythematous papules with intense pruritus over his face, neck, chest wall, and upper back. Initially, the eruption responded to therapy with topical or oral indomethacin and oral H1 antihistamine. However, the eruption was highly prone to recurrence, and it gradually failed to respond to these therapies. The eruption became chronic and persistent and manifested the excoriated, prurigo-like nodules that are typical of reported pruritic papular eruption, suggesting that this skin disease and HIV-associated eosinophilic pustular folliculitis are two forms of the same disease entity. UVB phototherapy in small doses was very effective for the persistent eruption, and no recurrence of the eruption was noted during or since the six-month maintenance therapy (once a week at a dose equivalent to 0.75 of the minimal erythema dose) (9 months total). No unfavorable side effects have been observed during or after the UVB phototherapy (cumulative UVB doses of 2,320 mJ/cm2).

Eosinophilic pustular folliculitis (Ofuji’s disease) without macroscopic pustules

“…Topical corticosteroid is another choice for first‐line topical treatment for EPF 10 . Ultraviolet B phototherapy 5 or topical tacrolimus 11 is also a preferable option for EPF. Case 3 showed tremendous remission after the application of tacrolimus ointment.…”

“…IS‐EPF is seen in the patients with acquired immunodeficiency syndrome 3 or the patients who had received a bone marrow transplant 4 . IS‐EPF shows severe pruritus and discrete erythematous papules with pustules 5 . I‐EPF was first described by Lucky et al.…”

Successful treatment of eosinophilic pustular folliculitis with topical tacrolimus

“…Various agents have been used to treat patients with EPF, with variable results, including topical and systemic corticosteroids, oral antibiotics, indomethacin, dapsone, PUVA, UVB and IFN‐γ 3–8 . Indomethacin is usually recommended as the first choice of treatment because of the short time required to achieve a good result.…”

Fototerapia: aplicações clínicas

“…Condições associadas ao HIV: tanto na foliculite eosinofílica como no prurido, a fototerapia com UVB dá excelente resposta sem piora do quadro imunológico e com controle dos sintomas. [39][40][41] Dessensibilização com UVB É indicada para portadores de urticária solar ou na erupção polimorfa solar. 34 Essas dermatoses acometem mais mulheres até a quinta década, são provocadas pela degranulação de mastócitos secundária a reações mediadas por IgE e induzidas pela luz visível ou qualquer comprimento de onda na faixa de ultravioleta.…”