Eosinophilic Pustular Folliculitis

Eosinophilic pustular folliculitis is a rare inflammatory skin condition. It causes recurring pustules, which are small bumps filled with pus, to appear on the skin. These pustules contain high levels of eosinophils, a type of white blood cell that fights infection and triggers allergic responses.

The condition has three main forms. The classic type affects mostly Japanese men. The HIV-associated variant occurs in people with advanced HIV or AIDS. The infantile form affects babies under 2 years old. Each type follows a similar pattern of recurring outbreaks that can last weeks or months.

This condition is not contagious and the pustules are sterile, meaning they contain no bacteria or infection. Instead, the pustules form due to an abnormal immune response in the hair follicles. While uncomfortable and sometimes distressing, the condition can be managed with proper diagnosis and treatment.

• Recurring pustules on the face, neck, trunk, or arms
• Intense itching that worsens at night
• Red, raised patches around the pustules
• Pustules that come and go in cycles
• Skin lesions that may leave darkened spots after healing
• Fever in some cases, especially in infants
• Scalp involvement with crusty patches in babies

The severity and location of symptoms vary by type. Some people experience mild outbreaks while others have severe, widespread lesions. Infants may show symptoms on the scalp and face, while adults typically develop pustules on the upper body.

The exact cause remains unclear, but the condition involves an overactive immune response. In HIV-associated cases, a weakened immune system triggers abnormal eosinophil activity in hair follicles. This variant typically appears when CD4 counts drop below 250 cells per microliter. The classic form may relate to immune system imbalances or hypersensitivity reactions. Some researchers believe fungal organisms or altered immune signaling play a role.

Risk factors include advanced HIV infection or AIDS, being of Japanese descent for the classic type, and being a young infant. Males are affected more often than females in the classic form. Infants with the condition usually have no underlying immune problems and often outgrow it by age 3. Environmental triggers and genetic factors may contribute, but more research is needed to understand the full picture of what causes this condition.

Diagnosis requires a skin biopsy to identify eosinophils in the hair follicles. A dermatologist removes a small tissue sample and examines it under a microscope. The presence of many eosinophils around and within follicles confirms the diagnosis. Blood tests help support the diagnosis and rule out other conditions. An eosinophil count measures the number of these white blood cells in your blood. Many people with this condition show elevated eosinophils, though not always.

Rite Aid offers testing for eosinophils as part of our flagship panel. Getting your eosinophil levels checked helps your doctor understand your immune system activity. Additional tests may include HIV screening, especially if HIV-associated eosinophilic pustular folliculitis is suspected. Your doctor will also rule out bacterial or fungal infections and other skin conditions that look similar.

• Topical corticosteroids to reduce inflammation and itching
• Indomethacin, an anti-inflammatory medication often effective for classic type
• Antiretroviral therapy for HIV-associated cases to restore immune function
• Topical tacrolimus or pimecrolimus for immune modulation
• Antihistamines to help control itching
• Phototherapy using ultraviolet light in resistant cases
• Dapsone, an antibiotic with anti-inflammatory properties
• Avoiding triggers that worsen outbreaks, such as excessive sweating
• Gentle skin care with mild cleansers and moisturizers
• Regular follow-up with a dermatologist to monitor progress