A Recalcitrant Case of Eosinophilic Pustular Folliculitis

Eosinophilic Pustular Folliculitis (EPF) or papulooerythroderma of Ofuji (PEO) is a rare dermatosis that presents with recurrent pruritic follicular papules and pustules that can involve the entire skin surface sparing the skin folds. This can be accompanied with elevated IgE levels and eosinophils. Diagnosis has been challenging due to its ability to mimic several common dermatologic disorders, such as acne and contact dermatitis. Literature has described the first line of therapy to be oral and topical indomethacin, however, success has been variable, and reports have been anecdotal. Until this day, there is yet to be standard guidelines for approach to diagnosis and management of this condition. In this article, we report a case of a 29 year-old female of Chinese descent who presented with papules on bilateral malar and nasal areas recalcitrant to topical corticosteroids. She demonstrated success with the use of a monthly regimen of isotretinoin after a perplexing diagnostic dilemma.