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Eosinophilic Dermatoses


As with the group of disorders known as neutrophilic dermatoses, there is significant overlap in the cutaneous findings of entities where eosinophils play a role – from papular urticaria triggered by arthropod bites to Wells syndrome and hypereosinophilic syndrome ( Fig. 20.1 ; Table 20.1 ). The exception is granuloma faciale, which has a more specific presentation.

Fig. 20.1
Evaluation of adult patients with eosinophilic dermatoses.
Histologically, these dermatoses are characterized by a prominent eosinophilic infiltrate and/or eosinophil granule protein deposition. Of note, systemic corticosteroids can significantly reduce the peripheral blood eosinophil count.

Table 20.1
Other disorders where eosinophils play a role (in addition to those listed in Fig. 20.1 ).
PUPPP, pruritic urticarial papules and plaques of pregnancy.

  • Parasitic infections (e.g. larva migrans, onchocerciasis, gnathostomiasis, strongyloidiasis)

  • Seabather’s eruption – after ocean swimming, pruritic papules in distribution of swimsuit; due to larvae of either jellyfish ( Linuche unguiculata ) or sea anemones ( Edwardsiella lineata )

  • Pruritic papular eruption of HIV disease – nonfollicular pruritic papules

  • Polymorphic eruption of pregnancy (also referred to as PUPPP) – urticarial plaques with involvement of striae and periumbilical sparing; pregnant women (third trimester, postpartum)

  • Pemphigoid gestationis – urticarial plaques and vesicles similar to bullous pemphigoid; pregnant women

  • Angiolymphoid hyperplasia with eosinophilia (epithelioid hemangioma) – nodules of the head and neck; adults

  • Langerhans cell histiocytosis (see Ch. 76 )

Limited to neonates or infants

  • Erythema toxicum neonatorum – papules and pustules with erythematous flare; neonates

  • Incontinentia pigmenti (stages I and II) – linear streaks of vesicles and keratotic papules along the lines of Blaschko

  • Infantile eosinophilic folliculitis – recurrent crops of pruritic follicular papules and pustules, primarily of the head and neck

Granuloma Faciale

  • Idiopathic disorder characterized by one or more persistent red-brown to violet-brown plaques on the face ( Fig. 20.2 ); prominent follicular openings are often noted and a third of patients have multiple plaques.

    Fig. 20.2, Granuloma faciale.

  • Most commonly occurs in middle-aged adults, and extrafacial involvement is unusual (<10% of patients).

  • The clinical diagnosis is confirmed via histopathology where eosinophils, neutrophils, and lymphocytes are seen in the dermis.

  • DDx: sarcoidosis, foreign body granuloma, granulomatous rosacea, and other entities that lead to persistent red to red-brown plaques of the face (see Fig. 99.2 ).

  • Rx: often difficult; intralesional CS, topical calcineurin inhibitors, cryosurgery, vascular lasers.

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