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Folliculitis of the buttocks and pinworms. A case report.

Folliculitis, both superficial and deep, has increased in frequency, particularly during the warm months of the year. The frictional trauma from tight-fitting jeans, with overhydration and maceration of the skin, has contributed to the increase. Folliculitis is usually accompanied by pruritus, but when pruritus precedes the folliculitis, there may be another cause in addition to the wearing of tight clothes. Such was the case in our patient who had anal pinworms (Enterobius vermicularis).

Adult↗

Eosinophilic folliculitis: a self-limiting illness in patients being treated for haematological malignancy.

Eosinophilic folliculitis is a recognized skin manifestation of human immunodeficiency virus (HIV) disease. Five cases of eosinophilic folliculitis occurring in HIV-negative patients treated for haematological malignancy are reported. In four cases this self-limiting, pruritic eruption, affecting the head and upper trunk, occurred 3 months after bone marrow transplantation, and the fifth case was a patient undergoing chemotherapy for Waldenström's macroglobulinaemia. This suggests that eosinophilic folliculitis is a consequence of disturbances of immune function, and is not specific for HIV infection.

Adult↗

Eosinophilic pustular folliculitis in infancy: report of two affected brothers.

We describe two brothers with eosinophilic pustular folliculitis. Both had recurrent crops of papules and pustules, primarily affecting the scalp. The eruption began in the neonatal period. Both children had a leucocytosis with eosinophilia. Histology revealed folliculitis, with an infiltrate in which eosinophils were predominant. Bacteriological and fungal cultures of pustules were negative. There was a good clinical response to treatment with a topical corticosteroid and dapsone. We review the 28 previously reported cases of eosinophilic pustular folliculitis in infancy. The occurrence of this disorder in brothers suggests that an inherited or contagious factor may be involved in its aetiology.

Adrenal Cortex Hormones↗

HIV seronegative eosinophilic pustular folliculitis successfully treated with doxicycline.

Eosinophilic pustular folliculitis (EPF) is an unusual disease, first described in adult East Asians in 1970 by Ofuji. It is characterized by follicular papules and pustules tending to coalesce and form plaques involving the trunk, face and extremities. In recent years, it has been often associated with human immunodeficiency virus (HIV) infection or with immunosuppressed and/or oncohaematological patients. EPF has been described in immunocompetent adult caucasian patients only occasionally. The diagnosis requires clinical and microbiological features such as sterile folliculitis and histopathological findings characterized by folliculitis and perifolliculitis with eosinophilic infiltrate. We describe an HIV seronegative caucasian male with EPF, allergic to non-steroidal anti-inflammatory drugs and indomethacin, treated with oral doxicycline. The treatment led to the complete remission of the lesions within 2 months.

Anti-Bacterial Agents↗

Eosinophilic pustular folliculitis in infancy.

Five infants under 1 year of age were reported with a syndrome of recurrent crops of pruritic papulopustules of the scalp. In three children there were also intermittent outbreaks on the trunk and extremities. Cultures showed the pustules to be sterile. Biopsies of scalp and skin tissues showed eosinophilic folliculitis. Some patients had eosinophilia during outbreaks of pustules. These cases are similar to the eosinophilic pustular folliculitis reported in a few adult patients with the exception that there was predominant scalp involvement in the children. We propose that eosinophilic pustular folliculitis of infancy is a distinct pustular dermatosis.

Child, Preschool↗

Recurrent Pseudomonas folliculitis.

Pseudomonas aeruginosa has attracted the attention of the dermatologic literature through repeatedly reported outbreaks of folliculitis occurring in small epidemics related to contaminated whirlpools, hot tubs, and swimming pools. In contrast, sporadic cases without these recreational exposures may present a diagnostic challenge. Two sisters, age 8 and 4 years, had sporadic Pseudomonas folliculitis. It is important to recognize the organism as the cause of this recurrent, papulopustular, follicular eruption on the trunk and gluteal regions, also called nonrecreational Pseudomonas folliculitis, to avoid misdiagnosis and mismanagment. Inadvertent therapy with steroids may result in rapid spread of the lesions. Unless a meticulous investigation of contaminant sources in the environment leads to the detection of the vehicle of infection, the dermatitis tends to recur and become chronic.

Baths↗

Comparative histopathology of pemphigus foliaceus and superficial folliculitis in the dog.

A comparative histopathologic study of 50 cases of pemphigus foliaceus and 47 cases of superficial folliculitis in the dog was undertaken to identify those histopathologic features important in differentiating these diseases. All cases were diagnosed by the Surgical Pathology Service of the Laboratory of Pathology of the University of Pennsylvania, School of Veterinary Medicine, between January 1986 and March 1991. These cases were followed clinically to determine the accuracy of the initial histopathologic diagnosis. Data were analyzed by Fisher's exact test for discrete data and the Mann-Whitney U-test for continuous data. A probability of < 0.05 was considered statistically significant. The following breeds were affected with pemphigus foliaceus: Akita, Brittany Spaniel, Chow Chow, Collie, Dachshund, Doberman Pinscher, English Cocker Spaniel, English Setter, Golden Retriever, Siberian Husky, Laborador Retriever, Miniature Schnauzer, Old English Sheepdog, Scottish Terrier, Chinese Shar Pei, Spitz, Shetland Sheep Dog, Weimeraner, and West Highland White Terrier. An increased risk of developing pemphigus foliaceus was noted in the Akita (OR = 37.8), English Springer Spaniel (OR = 20.7), Chow Chow (OR = 12.3), Chinese Shar Pei (OR = 7.9), and Collie (OR = 3.9). Pemphigus foliaceus had a higher average density of acantholytic cells (226 +/- 22.9) than superficial folliculitis (11.8 +/- 4.6), and acantholytic cells were 183 times more likely to be present in pemphigus foliaceus. The presence of rafts of acantholytic cells occurred in pemphigus foliaceus (23/50) more often than superficial folliculitis (1/47). Recornification and reformation of pustules were, respectively, 13.4 and 3.6 times more likely to occur in pemphigus foliaceus.(ABSTRACT TRUNCATED AT 250 WORDS)

Acantholysis↗

Genotypic relatedness of staphylococcal strains isolated from pustules and carriage sites in dogs with superficial bacterial folliculitis.

OBJECTIVE: To determine whether staphylococcal isolates cultured from pustules and carriage sites in dogs with superficial bacterial folliculitis were genotypically the same strain by use of pulsed-field gel electrophoresis (PFGE). ANIMALS: 40 dogs with superficial bacterial folliculitis. PROCEDURES: Samples were obtained from 3 pustules and 3 carriage sites (anus, axillary skin, and nasal mucosa). Bacterial culture, morphologic identification, Gram staining, catalase and coagulase tests, speciation, and PFGE were performed. RESULTS: Of 246 isolates, 203 were Staphylococcus intermedius, 5 were Staphylococcus aureus, 15 were Staphylococcusspp, and 22 were coagulase-negative staphylococcal isolates. No dog had an isolate with the same PFGE pattern as an isolate from another dog. Coagulase-positive isolates from multiple pustules and multiple carriage sites had the same PFGE pattern in 37 of 39 (94.9%) and 22 of 39 (56.4%) dogs, respectively. Coagulase-positive staphylococcal isolates from at least 1 pustule had the same PFGE pattern as an isolate from at least 1 carriage site in 34 of 36 (94.4%) dogs. Ninety-seven of 116 (83.6%) coagulase-positive staphylococcal isolates from pustules had the same PFGE pattern as an isolate from at least 1 carriage site. Sixty-nine of 91 (75.8%) coagulase-positive staphylococcal isolates from carriage sites had the same PFGE pattern as an isolate from at least 1 pustule. CONCLUSIONS AND CLINICAL RELEVANCE: Coagulasepositive staphylococcal strains were heterogeneous among dogs with superficial bacterial folliculitis. In individual dogs, strains from multiple pustules were genotypically the same, and strains from pustules were genotypically the same as strains from carriage sites.

Animals↗

Pseudomonas aeruginosa gram-negative folliculitis.

Three patients with sudden, unmanageable exacerbation of acne vulgaris were shown to have Gram-negative folliculitis due to Pseudomonas aeruginosa. In each patient, the source of the Pseudomonas proved to be an otitis externa infection. In contrast to previous cases of Gram-negative folliculitis due to Proteus, Escherichia coli, or Klebsiella, the anterior nares were not colonized. Treatment of the otitis externa and the Gram-negative folliculitis with acetic acid compresses and topical antibiotics led to prompt resolution without recurrence.

Acetates↗

Recalcitrant scalp folliculitis: a possible role of herpes simplex virus type 2.

We report the case of a 70-year-old man with a 1 year history of relapsing folliculitis of the scalp. Bacteriological, mycological and the Tzanck tests from the lesions were negative. Histopathological study showed suppurative perifollicular flogosis. Virological cultures were negative, while HSV nested polymerase chain reaction (nPCR) assays made on swabs and histological sections from the scalp lesions demonstrated the presence of herpes simplex virus type-2 (HSV-2) in all samples. Skin swabs of healthy areas yielded negative results for HSV-2 infection. The folliculitis showed a marked and quick improvement after therapy with famciclovir suggesting a possible etiologic role of HSV-2 in the scalp folliculitis.

Aged↗

Resistant scalp folliculitis secondary to Demodex infestation.

Folliculitis is a common complaint and its etiology may be related to a variety of factors. We examine a case involving a 57-year-old white man presenting with scalp erythema and folliculitis secondary to Demodex mite infestation. We discuss the pathophysiology of Demodex folliculitis, as well as the epidemiology, clinical manifestation, diagnosis, and treatment of this infection.

Anti-Infective Agents, Local↗

[A classical form of eosinophilic pustular folliculitis--successful therapy with PUVA].

Eosinophilic pustular folliculitis was first defined by Ofuji et al. in 1970 [13]. It is reported most frequently in Japanese patients. It is characterized by the repetitive appearance of sterile papulopustular lesions that heal without scarring. Case reports from outside Japan frequently refer to ulcerating inflammation. We describe a classic form of eosinophilic pustular folliculitis in an European, and we show for the first time that the eosinophilic pustular folliculitis responds well to PUVA treatment.

Adult↗

[Diagnosis of oil-induced folliculitis].

Clinical, electrophysiologic and immunologic study of 113 patients with oil folliculitis was carried out. High electric resistance of hair follicles was established along with some immunologic shifts, i.e., a decrease of the general number of T-lymphocytes in peripheric blood and of the level of G and A immunoglobulins, an increase of the CIC content. On the basis of the obtained data clinical species of oil folliculitis characteristic of the initial and late disease stages were determined. A complex of clinical, electrophysiologic and immunologic signs aimed at raising accuracy and objectivity of oil folliculitis diagnosis was proposed.

Adolescent↗

Methods for preventing pseudomonas folliculitis.

This outbreak highlights a number of significant factors related to most pseudomonas folliculitis outbreaks. The bath water had not been changed in more than four weeks which led to a build-up of high levels of organic carbon. There was an extended interval of six days between subsequent OTD chlorine residual tests, allowing the chlorine residual to decrease to low levels between tests. It should also be noted that the OTD test, by design, measures both the active free chlorine and the inactive combined chlorine residual. Therefore OTD residual readings in the low normal range may actually represent below normal free active chlorine residual levels. The following measures are suggested to reduce the growth of pseudomonads in hot tubs and whirlpool baths and to prevent subsequent cases of pseudomonas folliculitis: 1. The OTD chlorine residual should be checked every day. The residual should be well above the minimum level suggested for the bath. Or, preferably, an automatic chlorinator should be installed. This device measures the free chlorine residual and automatically adds chlorine to keep the residual in the desired range. 2. The water in the bath should be changed at least every eight weeks in order to reduce the total organic carbon level. The water should be changed more frequently if the bath is used by a large number of persons. 3. If an outbreak of pseudomonas folliculitis is associated with a bath, the water should be changed and the bath washed with a chlorine-based solution. Also, the method of keeping the chlorine residual in the operating range should be re-evaluated.

Baths↗

[Quinquad's folliculitis decalvans and tufted hair].

We observed a case of folliculitis decalvans involving the beard and the scalp with a tufted hair folliculitis aspect in the occipital region. The presence of two clinical presentations in the same patient has not been reported in the literature. This would suggest that the two entities could be morphological aspects of the same pathological process which might cause either atrophy with loss or the annexes or tufted hair folliculitis depending upon the depts and destructive capacity of the inflammatory process.

Aged↗

[AIDS-related eosinophilic folliculitis. Efficacy of high dose topical corticotherapy].

INTRODUCTION: A chronic pruriginous eruption of eosinophil-rich follicular papules and pustules is observed in AIDS patients. The pathogenesis of this disease, termed eosinophil folliculitis, is poorly understood and treatment is debated. CASE REPORT: A 30-year-old woman with AIDS developed highly pruriginous lesions of 5 month duration localized on the face, the trunk and upper limbs. There were papulo-pustules and excoriated papules. The elementary lesion was a follicular pustula. The eosinophil count was normal. The pathology examination revealed a rich eosinophil infiltration around the hair follicles and sebaceous glands as well as follicular spongiosis. Search for demodex, pityrosporons and a large number of infectious agents was negative. Oral minocyclin was uneffective. Local high-dose corticosteroids produced a remarkable effect and led to complete remission in 9 months. DISCUSSION: Most cases of eosinophil folliculitis associated with AIDS have been reported in men, but rarely in Europe. The remarkable efficacy of the local corticosteroid in this case was exceptional. This condition could result from inappropriate inflammatory reaction in AIDS induced by various factors including demodex and pityrosporon. Several therapeutic approaches have been proposed to eradicate the triggering factors and others to modify the immune response. The exceptional response to the short local treatment with corticosteroids would suggest that this approach could be proposed as first intention treatment in eosinophil folliculitis associated with AIDS.

Acquired Immunodeficiency Syndrome↗

Malassezia furfur folliculitis of the vulva: olive oil solves the mystery.

BACKGROUND: In treating women with chronic fungal infections, it is important to know which organism is responsible for the infection. In the past, organisms thought to cause vaginitis and vulvitis could all be cultured on modified Sabouraud agar. CASE: We describe a case of a woman whose chronic fungal vulvar folliculitis masqueraded as squamous epithelial hyperplasia. The 46-year-old woman, taking immunosuppressive therapy for rheumatoid arthritis, was referred with an 8-month history of vulvar vesicles, itching, and burning. Her examination revealed a vulvar folliculitis. When fungal cultures were initially negative, a vulvar biopsy revealed a squamous epithelial hyperplasia. However, a fungal culture covered with sterile olive oil eventually grew Malassezia furfur, a yeast with peculiar growth requirements. She was cured with a 2-week course of fluconazole. CONCLUSION: Malassezia furfur, an organism rarely described in the vaginitis literature, can cause vulvar folliculitis in a patient on immunosuppressive therapy.

Culture Media↗

[Ofuji's eosinophilic pustular folliculitis. Efficacy of acitretin].

BACKGROUND: We report the first case of eosinophilic pustular folliculitis (Ofuji's disease) which was successfully treated with acitretin. CASE REPORT: A 50-year old women (HIV negative) had developed over 3 months an erythematopapulous plaque under the left orbit. The clinical and histological diagnosis was eosinophilic pustular folliculitis. Successive treatment with cetirizine then indomethacin was ineffective. Acitretin (0.5 mg/kg/d) was then started and led to cure within 1 month. Six weeks after the patient spontaneously stopped the treatment, the lesion recurred at the same localization. Further treatment with isotretinoin (0.5 mg/kg/d) was then given but did not alter progression of the lesion. Acitretin was then reintroduced at the same dose and again produced rapid cure. Acitretin was then tapered off to 10 mg/d then maintained at this dose as lesions reappeared with further dose reduction. DISCUSSION: It is difficult to treat eosinophilic pustular folliculitis because of the random nature of response to different drugs. General corticosteroids, dapsone and indomethacin are classically proposed but with variable success. Isotretinoin is proposed on the hypothesis of a link with sebaceous secretion, but results have been contradictory. This drug was ineffective in our case. Acitretin did however provide very rapid improvement with an efficacy confirmed at reintroduction. This retinoid which does not have the specific action of isotretinoin could affect follicular keratinocytes which have been shown to be activated in this chronic skin disease.

Acitretin↗