Eosinophilic pustular folliculitis (EPF) of Ofuji presents as coalescing papulopustular plaques with central clearing and postinflammatory hyperpigmentation, occurring in otherwise healthy adults.1 In patients who are human immunodeficiency virus type 1-positive (HIV+), EPF occurs as pruritic, discrete erythematous urticarial follicular papules, usually distributed over the head and neck areas, sometimes with extension to the proximal aspect of the upper extremities and the upper aspect of the trunk, and may be a separate disorder.2 In previous reports and in our patients this condition tends to occur in late-stage disease, Walter Reed stages 5 and 6, with CD4 counts of less than 0.25 to 0.30×109/L.2 The eruption tends to be chronic and resistant to therapy, and although the majority of our patients have moderate-to-severe pruritus, they do not develop sepsis or other systemic symptoms that are directly related to EPF.
Demodex, Tinea, Pityrosporum, and Staphylococcus aureus have