Infantile Eosinophilic Pustular Folliculitis

Abstract

Background: Eosinophilic pustular folliculitis (EPF) is a cutaneous inflammatory follicular disorder of unknown etiology. The diagnosis is established on the basis of clinical and histopathologic features. In only a few instances has EPF been described in children. Objective and Methods: We describe the clinical and histopathologic features of a recurrent follicular eosinophilic pustular eruption involving the scalp in 2 children. Previously reported cases of EPF in childhood below 14 years of age are reviewed. Results: Two patients (9-month-old and 6-month-old boys) presented recurrent crops of follicular pustules on the scalp of 4 and 5 months’ evolution. The lesions resolved spontaneously without scarring. Histopathologic examination revealed an acute follicular inflammatory infiltrate with abundant eosinophils. Scraping from the lesions showed abundant eosinophils in 1 case. A peripheral eosinophilia was also detected in both patients. Conclusion: EPF in children below 1 year of age seems to represent a unique disorder bearing distinctive clinical (constant involvement of the scalp), evolutive (self-healing recurrent crops) and prognostic (the lesions may last until 3 years of age) features. A possible relationship between this disorder and other idiopathic pustular dermatoses of early childhood (especially with infantile acropustulosis) is suggested.

Eosinophilic pustular folliculitis of infancy: A series of 15 cases and review of the literature

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Twelve of the previously published cases were excluded, 13,20-27 some of which had already been questioned by other authors 28 : 1 atypical case on both clinical and histologic grounds (genital location exclusively, dermal infiltrate rich in neutrophils in 1 biopsy specimen, and in lymphocytes and macrophages in another) 25 ; 3 cases associated with immunodeficiency 26,27 ; 1 patient who developed sepsis with hepatic and pulmonary involvement in whom immunodeficiency was not ruled out 13 ; and 1 exceptional case in which the eruption did not recur, the histologic findings were inconclusive, and that was treated with granulocyte-colony stimulating factor (G-CSF) because of the extraordinarily high eosinophilia. 22 There were 6 more cases that were also excluded because of their atypical manifestations: a 4-year-old child who had recurrent vesicles and pustules along with erythema multiformeelike lesions on the abdomen and lower limbs that might have corresponded to arthropod bites 23 ; an 8-yearold boy with mucosal involvement, mixed dermal inflammatory infiltrate with eosinophils and neutrophils, and good response to dapsone in whom linear IgA was not excluded 20 ; an 11-year-old girl who presented with an isolated annular plaque on the cheek showing a dense eosinophilic infiltrate and necrotizing vasculitis of the small vessels, 24 which is not a feature of EPFI; a 5-year-old girl with ulcerated lesions on the lower legs that resolved in 2 weeks 21 ; and 2 more patients who presented with crops of pustular lesions on the trunk and lower limbs for 3 months' duration who demonstrated hypersensitivity to Dermatophagoides pteronyssinus and elevated IgE levels.…”

“…These were isolated cases, 3,5,7 whereas many patients were treated ineffectively with antibiotics before being given the diagnosis. [2][3][4][5][6][7][8][9]11,12,14,15,17,19 The good response could be considered as coincidental, because the process tends to be self-limiting, even without treatment, 15,18 but some authors favor the antichemotactic activity of some antibiotics such as erythromycin. 7 Cetirizine has also been successfully used by some authors, who advocate its antieosinophilic activity and antipruritic effect, 3 as has cimetidine.…”

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

“…The data were examined with regards to the epidemiology (age, sex, ethnic group), clinical characteristics (area of involvement, morphology and laboratory investigations) and treatment outcome. Cases of HIV-associated eosinophilic folliculitis 6 and paediatric EPF 7,8 were excluded, as these entities are clinically distinct from classic EPF.…”

Infantile acropustulosis in internationally adopted children

“…Finally, there may be some overlap in pustular diseases of infancy, 12 particularly infantile eosinophilic pustular folliculitis and IA, as suggested by several authors. [13][14][15] The coexistence of atopic dermatitis and elevated serum IgE was noted in earlier reports of IA. 15 Although Dromy et al 6 attributed this observation to coincidence, Mancini et al 8 reported that 5 of 21 patients with IA had coexisting atopic dermatitis.…”