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Eosinophilic Folliculitis


Folliculitis is a broad category of uncomfortable and unsightly skin conditions that occur when the hair follicles become inflamed or infected. There are several different types of folliculitis. Some are more common than others, and some are more easily treated than others. Some forms of folliculitis, such as the type of folliculitis that is caused by staph bacteria or another that is caused by yeast or fungus, are generally referred to as superficial folliculitis. These are generally small bumps or blisters that are red and appear on the surface of the skin much like a rash. These types of folliculitis are generally relatively easy to treat. Other types of folliculitis are characterized by large, painful welts that are painful and can cause scars. These are considered deep folliculitis and usually take longer and are more difficult to get rid of. One example of a deep folliculitis is eosinophilic folliculitis, a relatively unusual but very uncomfortable type.







What is Eosinophilic Folliculitis?


Eosinophilic folliculitis is a specific type of folliculitis that is a chronic condition that is known to recur in those who have been diagnosed with it. It is
not clear what causes the condition, but it is most often seen in four different types of patients. It is far more common in men then in women, when it occurs in adults it is generally those who are between the ages of twenty and forty, and it happens to five men for every woman who is diagnosed. The first and probably most common type of patient who is diagnosed with this condition is one who is severely immunocompromised, particularly those who have been diagnosed with HIV - in fact, the presence of eosinophilic folliculitis is often a way to confirm a diagnosis of HIV without a blood test. The disease is more commonly found in people who are from an Asian background, though it is also seen in African Americans and people of Hispanic origin.


Eosinophilic folliculitis can also be found in infants between the ages of five and ten months old, though this is generally much easier to treat then the condition as it appears in adults. Although nobody is clear on exactly what causes the condition, there is a theory that it is caused by an autoimmune reaction; the body may essentially exhibit an allergic reaction to its own sebum, an oily substance that is found coating the root of the hair follicle and also in the lower level of the epidermis. This would explain why the pustules can be found in areas other than simple the hair follicles of those who are afflicted with the condition.







Characteristics


Unlike other forms of folliculitis, eosinophilic folliculitis pustules do not contain any infection or bacteria, and they are not caused by yeast or fungus either. Despite this, the lesions can be extremely itchy and painful. They also can last for a very long time, and the healing process can take anywhere from a several months to a few years. Patients who develop this type of folliculitis generally have long periods of outbreaks that are followed by equally long periods of remission, but the condition almost always returns. The lesions generally appear on the face, thought they can also appear on the scalp, the back and shoulders, and on other areas of the body. The lesions often end up growing together into a single large pustule which then eventually heals from the center out. The condition often leaves behind an unsightly mark where the pustules had appeared that is dark and discolored, or else a scar.







Treatment


The goal of treatment for cases of eosinophilic folliculitis is to stop the spread of the lesions, as well as the inflammation that causes so much pain and itching; another goal is to stop the autoimmune reaction. The treatment that has been found to me the most effective and that is used most frequently has been the use of topical corticosteroids. Different strengths of creams can be used depending upon where the lesions have appeared. Stronger steroids can be used on areas where the skin is less sensitive, such as the scalp or back, where the face requires lower dosages.


Usually the creams or ointments are applied twice a day to best affect. Truly severe cases may also require the use of oral prednisone, and some patients have responded well to anti-rejection medications such as cyclosporine, and tacrolimus (another anti-rejection medication that is often used in organ transplant patients) seems to be particularly effective in infants who are diagnosed with the condition. Isotretinoin has also been shown to help, in large part because it stops the oil production that the body seems to be reacting to. Many patients also respond well to non-steroidal anti-inflammatory medications such as ibuprofen, acetaminophen and naproxen.


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