Clinicopathological study of itchy folliculitis in HIV-infected patients.
BACKGROUND
Itchy folliculitis are pruritic, folliculo-papular lesions seen in human immunodeficiency virus (HIV)-infected patients. Previous studies have shown that it was impossible to clinically differentiate between eosinophilic folliculitis (EF) and infective folliculitis (IF). Also, attempts to suppress the intense itch of EF were ineffective.


OBJECTIVE
The present study is aimed at correlating clinical, histopathological and immunological features of itchy folliculitis in HIV patients along with their treatment.


METHODS
The present prospective study lasted for 36 months (September, 2005 to August, 2008) after informed consent, data on skin disorders, HIV status and CD4 count were obtained by physical examination, histopathological examination and laboratory methods.


RESULTS
Of 51 HIV-positive patients with itchy folliculitis, the predominant lesion was EF in 23 (45.1%) followed by bacterial folliculitis in 21 (41.2%), Pityrosporum folliculitis in five (9.8%) and Demodex folliculitis in two (3.9%) patients. The diagnosis was based on characteristic histopathological features and was also associated with microbiology confirmation wherever required. EF was associated with a lower mean CD4 count (180.58 +/- 48.07 cells/mm3, P-value < 0.05), higher mean CD8 count (1675.42 +/- 407.62 cells/mm3) and CD8/CD4 ratio of 9.27:1. There was significant reduction in lesions following specific treatment for the specific lesion identified.


CONCLUSIONS
Clinically, it is impossible to differentiate itchy folliculitis and therefore it requires histopathological confirmation. Appropriate antimicrobial treatment for IF can be rapidly beneficial. The highly active antiretroviral therapy along with Isotretinoin therapy has shown marked reduction in the lesions of EF. Familiarity with these lesions may help in improving the quality of lives of the patients.
Annam
Vamseedhar
V
Department of Pathology, Sree Siddhartha Medical College, Hospital and Research Centre, Tumkur, Karnataka, India.
Yelikar
B R
BR
Inamadar
Arun C
AC
Palit
Aparna
A
Arathi
P
P
D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D002648:Child; D005260:Female; D005499:Folliculitis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D015474:Isotretinoin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011537:Pruritus / Q000150:complications* / Q000188:drug therapy / Q000473:pathology*; D055815:Young Adult
D015474:Isotretinoin