Eosinophilic folliculitis is a skin condition that causes inflammation around hair follicles. It can lead to itchy, pimple-like spots and pustules around the body.

Folliculitis refers to inflammation around hair follicles, which are collections of cells and connective tissues around the base of a hair. Folliculitis can occur anywhere on the skin except the palms of the hands and soles of the feet, where hair does not grow.

Eosinophilic folliculitis is a type of folliculitis where eosinophilic cells, or eosinophils, gather around the hair follicles. Eosinophils are a type of white blood cell, which fight infections and function within the immune system. They can build up in certain areas and cause inflammation.

This type of folliculitis typically occurs in people living with HIV. There is another type of eosinophilic folliculitis that mainly occurs in adults in Japan. Infantile versions of the condition also exist, which affect children from birth or within the first year of life.

Rarely, eosinophilic folliculitis may occur as a side effect of chemotherapy.

This article discusses the symptoms, causes, diagnosis, and treatment of eosinophilic folliculitis.

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The symptoms of eosinophilic folliculitis are similar to other forms of folliculitis and may include:

However, folliculitis symptoms vary from person to person. Some people may experience no symptoms at all, but others may have itchy and painful skin.

Learn more about scalp folliculitis here.

All forms of folliculitis are the result of inflammation around the hair follicles. The inflammation can be due to infection, injury, or irritation. The American Academy of Dermatology (AAD) lists several possible causes, including:

  • using hot tubs
  • shaving, plucking, or waxing hair
  • wearing tight clothing
  • applying medication on the skin, such as coal tar
  • gaining weight

Skin that is hot and damp is more vulnerable to damage and infection, which can lead to folliculitis.

People with eosinophilic folliculitis have eosinophils around their hair follicles. However, experts are unclear about what initially causes this accumulation of eosinophils or the disease to progress.

Learn more about hot tub folliculitis here.

HIV and eosinophilic folliculitis

Eosinophilic folliculitis is more commonly found in people living with advanced HIV or low CD4 counts. CD4 is a type of immune cell. HIV is a virus that attacks a person’s immune system. People living with HIV have a weakened immune system and are more vulnerable to infections.

Healthcare professionals are not clear about why there is a link between these conditions. However, it could be due to HIV causing imbalances in the immune system and underlying infection.

Learn more about the history of AIDS and HIV here.

A doctor or dermatologist may diagnose the condition by performing a physical examination of the symptoms and checking a person’s medical history. They will look out for patches of red, inflamed skin with pimple-like spots and pustules.

Doctors will perform a skin biopsy to check for eosinophils to diagnose eosinophilic folliculitis. A skin biopsy involves a doctor removing a small amount of skin to inspect under a microscope. The procedure is mostly painless as doctors will use an injection to numb the area before removing the skin.

Treatment for the condition varies depending on its severity and the presence of other conditions, such as HIV.

In mild cases, it may be possible to treat folliculitis at home. The AAD suggests applying a warm compress to the area 3–4 times a day for around 15–20 minutes each time. It also suggests avoiding shaving, plucking, or waxing, which can increase the risk of infection.

In other cases, medications may be necessary to treat the condition. People with underlying HIV will require antiretroviral therapy. This therapy will treat the HIV itself and improve symptoms of eosinophilic folliculitis.

Doctors may prescribe other types of medication when there is no virus. For example, they can use antibiotics to treat folliculitis due to a bacterial infection.

People should speak with a healthcare professional to determine the best course of treatment for them.

Folliculitis is a group of skin conditions that cause inflammation around the hair follicles. Eosinophilic folliculitis is a subtype of the condition where eosinophils are present around the hair follicles. Eosinophils are a type of immune cell.

However, experts are unclear about exactly what causes eosinophils to accumulate around hair follicles. There is a link between HIV and eosinophilic folliculitis. The impact HIV has on the immune system or an underlying infection can lead to eosinophilic folliculitis.

Doctors may treat this type of folliculitis with various medications depending on its severity. People living with HIV will require antiretroviral therapy to manage their HIV, which may then improve eosinophilic folliculitis symptoms.

A person should speak with a healthcare professional to determine the best course of treatment for them.