Eosinophilic Pustular Folliculitis: Epidemiology and Management

This chapter aims to review current knowledge on this condition and discuss a case of Eosinophilic Pustular Folliculitis (EPF) and its challenging therapeutic approach. Eosinophilic Pustular Folliculitis or papuloerythroderma of Ofuji is a rare dermatosis of unknown etiology characterized by chronic recurrent crops of pruritic papules and pustules in a follicular distribution that can cover entire skin, sparing the skin folds, accompanied with eosinophilia and elevated IgE. This can be accompanied with elevated IgE levels and eosinophils. A 29-year-old Chinese female presented to our dermatology office with a 1-month history of a worsening pruritic eruption of papules on the face. Prior treatment included ketoconazole cream, hydrocortisone 1% cream and antihistamines without improvement. Diagnosis has been challenging due to its ability to mimic several common dermatologic disorders, such as acne and contact dermatitis. Literature has described the first line of therapy to be oral and topical indomethacin, however, success has been variable, and reports have been anecdotal. Until this day, there is yet to be standard guidelines for approach to diagnosis and management of this condition.