Itchy folliculitis and human immunodeficiency virus infection: clinicopathological and immunological features, pathogenesis and treatment.
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.
Department of Dermatology, START Laboratory, Imperial College School of Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
L A
LA
Fearfield
A
A
Rowe
N
N
Francis
C B
CB
Bunker
R C
RC
Staughton
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D001327:Autoimmune Diseases / Q000473:pathology; D003881:Dermatomycoses / Q000150:complications / Q000473:pathology; D003937:Diagnosis, Differential; D004802:Eosinophilia / Q000188:drug therapy / Q000276:immunology / Q000473:pathology*; D005260:Female; D005499:Folliculitis / Q000188:drug therapy / Q000276:immunology / Q000473:pathology*; D006801:Humans; D016867:Immunocompromised Host; D008290:Malassezia; D008297:Male; D008924:Mite Infestations / Q000150:complications / Q000473:pathology; D012629:Sebum / Q000276:immunology; D012867:Skin / Q000382:microbiology / Q000469:parasitology