National Center for Advancing and Translational Sciences Genetic and Rare Diseases Information Center, a program of the National Center for Advancing and Translational Sciences

Eosinophilic pustular folliculitis


Other Names:
Ofuji's disease; Ofuji disease; Eosinophilic folliculitis, pustular; Ofuji's disease; Ofuji disease; Eosinophilic folliculitis, pustular; EPF; Eosinophilic folliculitis See More
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Eosinophilic pustular folliculitis (EPF) is a skin disorder characterized by recurring itchy, red or skin-colored bumps and pustules (bumps containing pus).[1] The condition is named after the fact that skin biopsies of this disorder find eosinophils (a type of immune cell) around hair follicles. The papules mostly appear on the face, scalp, neck and trunk and may persist for weeks or months.[1][2] EPF affects males more than females.[3][1]

There are several variants of EPF including classic eosinophilic pustular folliculitis (mainly occurring in adults in Japan); HIV-associated EPF, also referred to as immunosuppression-associated EPF; and infantile EPF (with onset from birth or within the first year of life).[1][3][4] Whether these are distinct disorders rather than variants of one disorder is controversial, partly because the underlying cause of EFP is not known.[1][3]

Several treatments have been described with variable results, including various oral or topical medications and phototherapy. In patients with HIV-associated disease, antiretroviral therapy tends to greatly diminish symptoms or even eliminate the condition.[1][3]
Last updated: 12/5/2016
A variety of treatment options for eosinophilic pustular folliculitis (EPF) have been described with variable results.[3] Individualized therapy should be tailored to the type of EPF present.[5]

The effectiveness of oral nonsteroidal anti-inflammatory drugs (NSAIDs) is well established for many cases of classic EPF (more than 70%), but the reason why remains unknown. There are cases in which NSAIDs are not effective.[6] For cases of classic EPF, common NSAID options for treatment include indomethacin (orally or topically) and acemetacin. Naproxen has also been used with some success. For classic cases that are not responsive to NSAIDs, other treatment options include:[3][5]
Additional treatment options that may improve symptoms include:[3][1][5]

The infantile form tends to respond well to topical corticosteroid therapy. It is important to recognize that this form typically resolves on it's own before age 3 in over 80% of cases, so observation or avoiding aggressive treatment is often recommended.[5]

In people with HIV-associated EPF, antiretroviral therapy tends to greatly diminish symptoms or even eliminate the condition.[3]

Last updated: 12/5/2016
The long-term outlook (prognosis) for people with eosinophilic pustular folliculitis (EPF) depends on the type of EPF present (classic, infantile, or immunosuppression-associated).

Classic EPF, which occurs mainly in adults, is generally chronic and recurrent but benign. Individual lesions typically last more than 1-2 weeks, and relapse every 3-4 weeks. Except for skin involvement, people with classic EPF are generally in good health with no systemic symptoms.

Infantile EPF generally also runs a benign course, and resolves on its own by 3 years of age in over 80% of cases. It is important to recognize that this form is self-limiting so as to avoid unnecessary aggressive treatment in affected infants. Children with this form also generally remain in good health without associated problems, although a possible association with atopy (tendency to develop allergies) has been speculated.

The immunosuppression-associated type of EPF is mainly associated with HIV infection, hematological malignancy (blood cancers), or other cancers, so recognizing that a person has this form of EPF is important. The overall prognosis beyond the skin symptoms largely depends on the prognosis associated with the underlying condition.[7]
Last updated: 12/6/2016

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

Organizations Providing General Support

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

  • DermNet NZ is an online resource about skin diseases developed by the New Zealand Dermatological Society Incorporated. DermNet NZ provides information about this condition.

In-Depth Information

  • Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
  • The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
  • PubMed is a searchable database of medical literature and lists journal articles that discuss Eosinophilic pustular folliculitis. Click on the link to view a sample search on this topic.

Questions sent to GARD may be posted here if the information could be helpful to others. We remove all identifying information when posting a question to protect your privacy. If you do not want your question posted, please let us know. Submit a new question

  • I am trying to find out information about how this may be treated, if it is an autoimmune disorder (I have been told that it is autoimmune by one provider, and a second provider told me that is in not autoimmune, but an allergy disorder), and how it will affect my son during his life. Will this weaken his immune system? See answer


  1. Scott Barker and Amanda Oakley. Eosinophilic folliculitis. DermNet NZ. April, 2014; http://www.dermnetnz.org/topics/eosinophilic-folliculitis/.
  2. Peter F Weller and Amy D Klion. Eosinophil biology and causes of eosinophilia. UpToDate. Waltham, MA: UpToDate; November, 2016;
  3. Robert A Schwartz. Eosinophilic Pustular Folliculitis. Medscape Reference. June 9, 2016; http://emedicine.medscape.com/article/1070326-overview.
  4. Fujiyama T, Tokura Y. Clinical and histopathological differential diagnosis of eosinophilic pustular folliculitis. J Dermatol. June, 2013; 40(6):419-423.
  5. Nervi SJ, Schwartz RA, Dmochowski M. Eosinophilic pustular folliculitis: a 40 year retrospect. J Am Acad Dermatol. August, 2006; 55(2):285-289.
  6. Katoh M, Nomura T, Miyachi Y, Kabashima K. Eosinophilic pustular folliculitis: a review of the Japanese published works. J Dermatol. January, 2013; 40(1):15-20.
  7. Hai Long, Guiying Zhang, Ling Wang, Qianjin Lu. Eosinophilic Skin Diseases: A Comprehensive Review. Clinical Reviews in Allergy & Immunology. April, 2016; 50(2):189-213.