Eosinophilic folliculitis in two HIV-positive women: case reports and literature review.

Human immunodeficiency virus-associated eosinophilic folliculitis (HIV-EF) among homosexual men is a commonly reported dermatologic finding while only four cases in HIV-positive women have been documented in the literature to date. This report describes two additional cases of HIV-EF in immunocompromised women and reviews the data on this condition. Two HIV-positive women were seen because of intensely pruritic eruptions on the face that were resistant to treatment. Cutaneous examination revealed numerous erythematous, well-defined papules without scale or crust. Additionally, one of the women had excoriated papules on the upper arms. At the time of consultation, both women had CD4 cell counts below 100 cells/[micro]l. Microscopic examination of the skin biopsies demonstrated a mixed infiltrate of lymphocytes with scatted intact and degranulated eosinophils in the dermal perivascular and perifollicular regions. Periodic Acid Schiff staining was negative for fungal infections. Because the etiology of HIV-EF remains elusive, diagnosis is based on clinical appearance and microscopic analysis of skin biopsies. In addition, nearly all cases of HIV-EF are in patients with a CD4 cell count below 300 cells/[micro]l. No one therapy stands above the rest although several successful pharmacologic regimens have been reported. Highly active retroviral therapy restores the proper T-cell milieu, which seems to benefit the course of this disease. As HIV infection continues to increase in the female population, more cases of HIV-EF in women will be seen which underscores the fact that this condition is no longer a disease found solely in homosexual men. Physicians, especially those who provide primary care for HIV-positive women, need to be aware of this condition because it is often overlooked, is very difficult to treat, and is a continual aggravation for those inflicted by it.

Benjamin B. Hayes, MD, PhD, Lynne J. Goldberg, MD, and Mukta Panda, MD. Department of Medicine, University of Tennessee College of Medicine-Chattanooga Unit, Chattanooga, TN. Dermatopathology Section. Department of Dermatology, Boston University School of Medicine, Boston, MA.