Eosinophilic folliculitis (EF), previously referred to as Ofuji’s disease, is a common intensely pruritic condition often occurring in advanced HIV or the setting of IRIS, commonly 3-6 months post commencement of ART. (135) Although some believe that eosinophilic folliculitis and pruritic papular eruption (PPE) are part of the same disease spectrum, the distribution of both …
Eosinophilic folliculitis presents as intensely pruritic 2-3 mm erythematous oedematous urticarial papules centred on follicles and may have pustules. The distribution is typically over the forehead, neck, shoulders, trunk and upper arms. In women living with HIV, PPE may more predominantly involve the face and therefore mimic acne excoriae. (138) Due to the associated pruritus, …
The differential diagnosis is difficult and includes the common causes found in patients without HIV such as insect bite reactions, scabies, dermatitis herpetiformis, drug reactions, atopic dermatitis and bacterial folliculitis. Skin biopsy for histopathological assessment be helpful, however EF and PPE have overlapping histological features and thus should be used primarily to support clinical diagnoses. …
Depending on the cause, management varies, particularly if an infective cause such as scabies is found. Eosinophilic folliculitis and pruritic papular eruption can be difficult to manage with the pruritus often unresponsive to traditional therapies. Case reports of both EF and PPE remission following commencement of ART have been reported. (139, 140) Treatment options for …
Drug reaction, eosinophilia and systemic symptoms (DRESS) Drug reaction, eosinophilia and systemic symptoms (DRESS) is a rare severe cutaneous adverse reaction (SCAR) seen more commonly in PLWHIV. (143) DRESS can develop as a SCAR to medications, including ART agents such as abacavir or raltegrovir which demonstrate association with HLA genotypes HLA-B*57:01 and HLA-B*53:01, respectively. (144-146)
The disease is characterised by cutaneous eruption which can take on any morphology, fever, lympadenopathy and the presence of eosinophilia or atypical lymphocytes and solid organ inflammation on laboratory investigation. Common end organs affected include the heart, lung, kidneys and liver. Mortality approaches 20% if untreated, usually as a result of hepatotoxicity. (143)
The diagnosis is usually clinical, and may be aided by the REGISCAR scoring system. (147) Skin biopsies usually reflect the morphology of the cutaneous eruption but are not specific to DRESS. The eosinophilia may be delayed, developing days after the first skin signs are noted.
Identification and cessation of the causative medication is paramount. High dose corticosteroids, eg prednisolone 1mg/kg/day are the cornerstone of treatment. This is usually tapered over a period of 6-12 weeks. Guidelines do not suggest differing treatment for DRESS in PLWHIV. Following the acute phase, DRESS patients are at risk of autoimmune sequelae such as diabetes …
Deeks SG, Overbaugh J, Phillips A, Buchbinder S. HIV infection. Nature reviews Disease primers. 2015;1(1):1-22. Hogan MT. Cutaneous infections associated with HIV/AIDS. Dermatologic clinics. 2006;24(4):473-95. Veenstra J, Krol A, van Praag RME, Frissen PMJ, Schellekens PTA, Lange JMA, et al. Herpes zoster, immunological deterioration and disease progression in HIV-1 infection. Aids. 1995;9(10):1153-8. Strick LB, Wald …
Jason Ong1,2, Jenny McCloskey2, Winnie Tong3 1.Central Clinical School, Monash University Department of Clinical Research, London School of Hygiene and Tropical Medicine Sexual Health Clinic, Royal Perth Hospital, Perth, WA Department of Clinical Immunology, St Vincent’s Hospital, Sydney, NSW Last reviewed: November 2019 Introduction The human papillomavirus (HPV) is a DNA virus from the papillomavirus …
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