Ofuji's disease with follicular mucinosis and its differential diagnosis from alopecia mucinosa.
OBJECTIVE
Ofuji's disease (OD) or eosinophilic pustular folliculitis and human immunodeficiency virus-associated eosinophilic folliculitis (HIV-EF) both show eosinophil-rich folliculocentric infiltrates, and it is not clear whether they are distinguishable pathologically. Follicular mucinosis (FM) has been observed in lesions of EF; such cases need to be differentiated from alopecia mucinosa (AM).


METHODS
We compared various pathologic features in 13 cases of OD, 10 cases of non-OD-typed papular EF (seven HIV-positive and three HIV-negative), and five cases of AM.


RESULTS
All cases of EF showed eosinophilic infiltrates affecting mainly the isthmus or/and sebaceous gland. Eosinophil-rich pilosebaceous pustules or/and microabscesses were noted in 69% of the biopsy specimens of OD, 73% of papular EF, 71% of HIV-EF, and 0% of AM. Mucin deposits, often abundant, were found in sebaceous lobules or/and isthmus in 41% of OD and 100% of AM. Compared with AM, OD with FM tended to show more numerous eosinophils, less abundant mucin, and most significantly, eosinophilic infundibular pustule or sebaceous microabscess.


CONCLUSIONS
Our study suggests that OD and HIV-EF are indistinguishable pathologically and the diagnosis requires clinical correlation. FM was not uncommonly seen in lesions of OD. OD with FM may be difficult to differentiate from FM, especially in cases presenting with non-annular or non-pustular lesions, but the diagnosis might be facilitated by finding eosinophil-rich pustule, microabscess, or infiltrate in pilosebaceous units microscopically.
Lee
J Yu-Yun
JY
Department of Dermatology, National Cheng Kung University, Tainan, Taiwan. yylee@mail.ncku.edu.tw
Tsai
Ya-Ming
YM
Sheu
Hamm-Ming
HM
D000293:Adolescent; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D004802:Eosinophilia / Q000209:etiology / Q000473:pathology*; D005260:Female; D005499:Folliculitis / Q000209:etiology / Q000473:pathology*; D015658:HIV Infections / Q000150:complications / Q000473:pathology; D018859:Hair Follicle / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000507:Mucinosis, Follicular / Q000473:pathology*; D012627:Sebaceous Glands / Q000473:pathology; D012872:Skin Diseases, Vesiculobullous / Q000209:etiology / Q000473:pathology*; D013492:Suppuration / Q000473:pathology