Two cases of eosinophilic pustular folliculitis associated with parasitic infestations

Abstract

Two patients presented with papular eruptions that could not be diagnosed clinically. Biopsies of these lesions showed eosinophilic pustular folliculitis (EPF). Both cases were subsequently found to have infestations: one as a result of cutaneous larva migrans was successfully treated with ivermectin and the other caused by scabies mites was successfully treated with topical pyrethrin. The two cases of EPF presented emphasize the need for careful clinicopathological correlation to determine the cause.

Follicular cutaneous larva migrans: a report of three cases and review of the literature

“…Pelodera strongyloides is a nematode belonging to the order Rhabditida, which lives in cold areas (latitude 40–60°) and usually affects the skin of dogs, cattle, horses, and sheep. Subsequently, 20 cases of follicular HrCLM have been published (Table ) . Follicular HrCLM occurs especially in adults; only one non‐adult case, occurring in a 6‐month‐old infant, has been described .…”

“…Histopathologically, HrCLM is characterized by mild edema in the upper dermis and perifollicular infiltrate predominantly consisting of lymphocytes and eosinophils . Granulomatous infiltrates were also observed .…”

Diseases of cutaneous appendages

“…258 In one patient, the eruption appeared to be related to the use of foscarnet therapy. 271,272 The miscellaneous group includes patients in whom bacteria, such as Pseudomonas, have been isolated and patients with myeloproliferative or other hematological disorders. 260 Pediatric (childhood) eosinophilic pustular folliculitis is usually confined to the scalp, although grouped aggregates of follicular pustules can occur on the face, extremities, and trunk in some patients.…”

Cytologic Findings of Eosinophilic Dermatoses: a Retrospective Analysis of 88 Patients

“…The presence of more than 10 tadpole-like cells (at x100 magnification) is highly specific (99.3%-100%) for acute spongiotic dermatitis (6,12 In this study, another important cause of cutaneous eosinophilic infiltration was fungal and parasitic infections (19.3%). Infectious eosinophilic folliculitis can occur with scabies, Demodex, Pseudomonas infections, and larva migrans, Malassezia species, and in dermatophytic folliculitis, especially Trichophyton rubrum as in our patients (9)(10)(11)13,14). A definitive diagnosis of cutaneous infectious diseases should be based on detecting the cause through cytology, histopathologic examination, culture techniques, or molecular diagnostic methods such as polymerase chain reaction.…”

“…However, histopathologic examination may pose a diagnostic challenge for dermatopathologists as an identical histologic picture can be produced by several different causes. In such cases, cytology can be useful for diagnosis (5,(9)(10)(11). In this study, we presented the cytologic findings of 88 patients with eosinophilic dermatoses.…”