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March 1995

Eosinophilic Folliculitis Associated With the Acquired Immunodeficiency Syndrome Responds Well to Permethrin

Author Affiliations

Dermatology Branch National Cancer Institute Bethesda, MD 20892

Arch Dermatol. 1995;131(3):360-361. doi:10.1001/archderm.1995.01690150126032

Eosinophilic folliculitis (EF) associated with the acquired immunodeficiency syndrome (AIDS) is a chronic pruritic papulovesicular disease with distinctive clinicopathologic features.1-3 The cause of this condition is unknown, although it has been postulated to be caused by an infectious organism within the pilosebaceous unit.1,3 Tissue eosinophilia as observed in EF suggests that the purported pathogen is parasitic rather than bacterial, viral, or fungal. We describe six AIDS patients with EF who had increased numbers of Demodex folliculorum mites seen in skin biopsy specimens and scrapings from unexcoriated urticarial lesions. Previously, these patients had had treatment-resistant disease, yet all of them improved with topical permethrin, a synthetic pyrethroid with potent insecticidal properties. We propose that EF may represent an inappropriate immune response directed against Demodex and that this may be secondary to increased Th2-like cytokines produced in advanced human immunodeficiency virus (HIV) disease.

Subjects and Methods.  Six AIDS patients presented

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