Itchy folliculitis and human immunodeficiency virus infection: clinicopathological and immunological features, pathogenesis and treatment

• Published in: British journal of dermatology (1951) Vol. 141; no. 1; pp. 3 - 11
• Main Authors: FEARFIELD, L. A, ROWE, A, FRANCIS, N, BUNKER, C. B, STAUGHTON, R. C. D
• Format: Journal Article
• Language: English
• Published: Oxford BSL Blackwell Publishing Ltd 01.07.1999; Blackwell
• Subjects: AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - etiology; AIDS-Related Opportunistic Infections - pathology; AIDS/HIV; autoimmune disease; Autoimmune Diseases - pathology; Biological and medical sciences; clinical features; Dermatomycoses - complications; Dermatomycoses - pathology; Diagnosis, Differential; Eosinophilia - drug therapy; Eosinophilia - immunology; Eosinophilia - pathology; eosinophilic folliculitis; Female; Folliculitis - drug therapy; Folliculitis - immunology; Folliculitis - pathology; histopathology; human immunodeficiency virus; Human viral diseases; Humans; Immunocompromised Host; Infectious diseases; Malassezia; Male; Medical sciences; Mite Infestations - complications; Mite Infestations - pathology; Sebum - immunology; Skin - microbiology; Skin - parasitology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Human; Immunopathology; Opportunistic infection; Skin disease; Pathogenesis; AIDS; Folliculitis; Review; Immune deficiency; Infection; Pathology; Symptomatology; Treatment; Viral disease
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1046/j.1365-2133.1999.02914.x

The predominant itchy folliculitis associated with human immunodeficiency virus (HIV) infection appears to be an eosinophilic folliculitis (EF). This is characterized by lytic degeneration of sebaceous glands and an inflammatory infiltrate in which eosinophils and CD8+ T lymphocytes predominate. All patients have low CD4 counts and present late on in their HIV disease. Lesional distribution is mainly truncal, with a significant proportion also having facial involvement. Our prospective survey has shown that it is impossible to differentiate clinically between infective folliculitis and EF, and we recommend therefore that all cases are biopsied. We review the clinicopathological and immunological aspects of HIV‐associated itchy folliculitis, in particular HIV‐associated EF as well as current theories on pathogenesis and treatment. We suggest that HIV‐associated EF is an autoimmune disease with the sebocyte or some constituent of sebum acting as the autoantigen.