Pyodermitis of Genital Areas: An Atypical Manifestation of Eosinophilic Pustulosis of Childhood

Abstract

Eosinophilic pustulosis of the scalp was first described in 1984. It has also been described in other sites than the scalp. We report a case in which the lesions exclusively involved the genitals. A 4-month-old boy presented with papulopustular lesions of the genitals in the form of pyodermitis with a favourable course over several days but which subsequently recurred. A smear of a pustule revealed no signs of scabies or viral, fungal or bacterial infection. Histology showed a non-follicular eosinophilic pustulosis. This case emphasizes the ubiquitous and sometimes misleading nature of eosinophilic pustulosis and the non-follicular nature of the lesions.

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.…”

“…5,15 IgE levels were available in only 13 patients 2,3,5,6,10 ; they were very high in 1, 10 a patient who showed hypersensitivity to the dust mite D pteronyssinus, and only slightly elevated in 2. 5 The age at resolution ranged from 4 months to 9 years (mean 25 with intervals spanning from 1 to 12 weeks, with a time of resolution ranging from 7 to 30 days. Over 80% of children experienced resolution by 3 years of age (Fig 4).…”