Skin: eosinophilic folliculitis and furunculosis

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Sections available in full article Introduction, Presenting signs, Age predisposition, Breed predisposition, Pathogenesis, Predisposing factors, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Differential diagnosis, Treatment, Initial symptomatic treatment, Standard treatment, Monitoring, Subsequent management, Prevention, Control, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Ms Susan E Shaw BVSc (Hons) (Syd) MSc DipACVIM DipECVIM FACVSc MRCVS
Dr Rosanna Marsella DVM DipACVD
Synonyms Sterile eosinophilic folliculitis and furunculosis

Introduction

  • Cause : ?insect/arachnid hypersensitivity.
  • Signs : pruritic maculopapular rash, rapidly progressing to ulceration.
  • Affects sparsely haired areas of face, eg bridge of nose.
  • Diagnosis : history, clinical signs, histopathology, cytology, microscopy, bacteriology.
  • Treatment : topical and systemic antimicrobial therapy.
  • Prognosis : good.

Diagnosis

Clinical signs

  • Facial edema.
  • Multifocal papules and pustules Folliculitis.
  • Ulceration.
  • Pruritus.
  • Bridge of nose usually affected.
  • Also affects pinnae, ventrum and limbs.
  • Secondary pyoderma.
  • Pain.
  • Excoriation.
  • Thickened fibrotic plaque formation in chronic lesions.
  • Heals with scarring if not rapidly treated.
  • Depression.
  • Pyrexia.
  • Lymphadenopathy.

Diagnosis

Differential diagnosis

  • Pyoderma Skin: bacterial skin disease - overview.
  • Hypersensitivity.
  • Ectoparasitic infection Skin: parasitic disease - overview.
  • Dermatophytosis Skin: dermatophytosis.
  • Fungal infection Skin: dermatophytosis.
  • Subcutaneous mycosis.
  • Demodicosis Skin: demodectic mange.
  • Immune-mediated skin disease Skin: immunological disease - overview.
  • Physical causes, eg contact irritant dermatitis Skin: allergic contact dermatitis , candidiasis Skin: candidiasis and other deep mycotic infections.
  • Neoplasia Skin: neoplasia.
  • Sterile eosinophilic pustular dermatitis.
  • Drug eruption.
  • Erythema multiforme Skin: erythema multiforme.
  • Pythiosis.

Sequelae

Prognosis

  • Good.
  • Often results in permanent scars (if not treated with glucocorticoids).
  • May recur.

Expected response to treatment

  • Marked improvement in clinical signs after 48-72 hours glucocorticoid therapy.
  • Complete resolution may take many months if treatment is delayed.

Reasons for treatment failure

  • Secondary pyoderma present and not treated.
  • Lesions due to deep pyoderma Skin: deep pyoderma - not eosinophilic folliculitis and furunculosis.

Sources

Publications

Refereed papers

  • Bevier D E (1999) Insect and arachnid hypersensitivity. Vet Clin North Am Small Anim Pract 29 (6), 1385-1405.
  • Curtis C F, Bond R, Blunden A S, Thomson D G, McNeil P E & Whitbread T W (1995) Canine eosinophilic folliculitis and furunculosis in 3 cases. JSAP 36 , 119-123.
  • Scott D W (1988) Canine sterile eosinophilic pinnal folliculitis. Camp An Pract 2 , 19-22.
  • Scott D W (1987) Sterile eosinophilic pustulosis in dog and man - comparative aspects. J Am Acad Dermatol 16 (5 Pt 1), 1022-1026.

Other sources of information

  • Scott D W, Miller W H & Griffin C E (1995) Small Animal Dermatology. 5th edn. Philadelphia: W B Saunders. ISBN 0 7216 4850 9.
  • Yager J A & Wilcock B P (1994) Color Atlas and Text of Surgical Pathology of the Dog and Cat. London: Wolfe Publishing, Mosby Year Book Europe. ISBN 0 7234 1827 6.
  • Gross T L, Irkhe P J & Walder E J (1992) Veterinary Dermatopathology. St Louis: Mosby Year Book. ISBN 0 8016 5809 8.

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