Last modified: May 20, 2019
Richard Honaker M.D.View Full Profile
Could the itchy red bumps on your body be a sign your immune system is compromised?
Itchy red and acne like bumps are unfortunately a common skin condition for many people. While often mistaken for acne, folliculitis is actually characterized by the inflammation of the hair follicle rather than pores clogged with oil and dead skin.
While many types of folliculitis are common, eosinophilic folliculitis is much rarer. In fact, the cause of this skin condition is not known and the lesions are not confined to the hair follicle. While not always the case, these itchy, red and often pus-filled bumps can be a sign that your immune system in compromised.
We asked Dr. Honaker to share with us their knowledge on this rare skin condition.
What is Eosinophilic Folliculitis?
While the direct cause of this condition is not known, the name of the condition does give some clues. Let’s take a look at the first word of the name: Eosinophilic.
Eosinophils are a normal part of the cells of the blood and some tissues. When the body has to fight off a foreign substance, such as an allergy, eosinophils will travel to that part of the body and release toxins. However, if too many toxins are released it can cause inflammation of the area.
Folliculitis is named for the hair follicle. Common folliculitis occurs when the hair follicle is damaged through common events such as shaving, tight clothing and ingrown hair. Eosinophilic folliculitis is when the damage is caused by an internal inflammation.
This skin condition was named after a Japanese woman presented this unusual skin condition in 1965. The name was much debated since the inflammation is not restricted to only the hair follicle in these cases.
What Does Eosinophilic Folliculitis look like?
The appearance of eosinophilic folliculitis is very similar to acne. Small red or skin colored bumps will appear on the face, neck, scalp and trunk of the body. These bumps are often filled with pus.
Not only are the bumps often unsightly, but they can also be very itchy. These will appear on the face in 85 percent of cases. In infants, the scalp is most often affected.
In cases of common eosinophilic folliculitis lesions usually last one to two weeks and reoccur every three to four weeks. While their skin can be inflamed and itchy, this condition does not affect other parts of the body and the person is generally often in good health.
Who is at risk for Eosinophilic Folliculitis?
There are three different variants of Eosinophilic Folliculitis. The first is infancy-associated eosinophilic folliculitis. This condition often occurs between five and 10 months old. Children ‘grow out’ of this condition by age three with no intervention in 80 percent of cases.
The second is immunosuppression-associated eosinophilic folliculitis. Many refer to this condition as the ‘calling-card’ of HIV. This can also be associated with other types of immune deficiency such as some cancers and organ transplant recipients.The appearance of eosinophilic folliculitis can be a sign of deficient immune system. HIV-associated eosinophilic folliculitis is more common amongst bi-sexual and gay men.
The third type is common eosinophilic folliculitis. This condition can occur even with a healthy immune system. It is five times more likely to appear in males than females. While eosinophilic folliculitis can occur in caucasian, hispanic and black persons but is more common in those with Asian descent. Eosinophilic folliculitis is most common among those 20-40 years old.
How is Eosinophilic Folliculitis Treated?
There are a variety of different treatment options available with a wide variety of results. The treatment plan needs to be individually tailored for the type of eosinophilic folliculitis as well as any other diagnosis the patient may have.
With common eosinophilic folliculitis oral nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in 70 percent of cases. In cases where there NSAIDs are not effective, other treatments include antibiotics and topical and systemic steroids.
Although no intervention is needed for infancy-associated eosinophilic folliculitis in 80 percent of cases, those who do need treatment often benefit from topical corticosteroid therapy.
Antiretroviral therapy tends to greatly diminish symptoms or even eliminate the condition in people with HIV-associated EPF.
Support for those with Eosinophilic Folliculitis
If you or a loved one are suffering from eosinophilic folliculitis there is support available. You can contact the American Association of Dermatology or Skin Support in the UK to get connected to local support group in your area.
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