20
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).
• Scabies – see Chapter 71
• Parasitic infections (e.g. larva migrans, onchocerciasis, schistosomiasis, 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 periumbilicial sparing; pregnant women
• Pemphigoid gestationis – urticarial plaques and vesicles similar to bullous pemphigoid; pregnant women
• Angiolymphoid hyperplasia with eosinophilia – nodules of the head and neck; adults
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 Blaschko’s lines
• Infantile eosinophilic folliculitis – recurrent crops of pruritic follicular papules and pustules, primarily of the head and neck
PUPPP, pruritic urticarial papules and plaques of pregnancy.
Granuloma Faciale
• Idiopathic disorder characterized by a persistent red-brown to violet-brown plaque 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. Red-brown plaques on the lateral cheek (A) and nose (B). Note the prominent follicular openings. B, Courtesy, Cloyce L. Stetson, MD.
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