蔡醫師2003年發表在中華皮膚科醫學雜誌的文章。

太藤氏病(Ofuji’s disease, OD),又名為嗜伊紅球性膿疱性毛囊炎(eosinophilic pustular fol-liculitis, EPF),特色為反覆發作、具癢感之毛囊丘疹及環狀板塊,並有膿疱散佈其上,好發在臉上。
HIV-associated eosinophilic folliculitis (HIV-EF)臨床上則為許多散在性、毛孔一致性之的蕁麻疹樣丘疹,通常發在上半身。
兩種EF的病理特徵都是無菌、膿疱性毛囊炎並有嗜伊紅球之浸潤。

在過去十三年間,本科根據臨床及病理所見,共診斷23個EF病例。
其中16例為non-HIV EF(男性5位,女性11位,發病年齡自12至50歲,平均33歲),而另7例為HIV-EF(男性7位,35至67歲,平均48歲)。
在non-HIV患者中,13例表現典型之OD,3例則為HIV-EF型之papular EF。
23例有10例有週邊血液嗜伊紅球增多。
HIV-EF病例則有CD4降低(平均133/mm3)所有病例之切片均可見特徵性嗜伊紅球性毛囊火及毛囊周圍炎併毛囊皮脂腺內之膿皰或微小膿瘍之變化。
較特別的是,6例OD之病灶中可見黏液沈積在毛囊皮脂腺。

治療方面,包括prednisolone、indomethacin、napproxen、diclofenac、doxycycline、dap-sone、ultraviolet B。
以prednisolone治療的15例中,除了2位HIV-EF患者外,其餘皆有效。
Indomethacin對4例有效。
其餘療法則無顯著效果。
約一半non-HIV患者在兩年內自行痊癒,但HIV患者則無自行痊癒的情形。

由我們的經驗看來,EF在台灣似乎不罕見,臨床及病理須與皮癬菌感染、酒渣、毛囊黏液症等作鑑別診斷。

Ofuji’s disease (OD), also named eosinophilic pustular folliculitis (EPF), is characterized by recur- rent pruritic folliculopapules and discoid or annular plaques studded with pustules, which occurs mainly on the face. HIV-associated eosinophilic folliculitis (HIV-EF) typically manifests discrete urticarial fol- liculopapules, mostly on the upper trunk. Both forms of EF are characterized by sterile pustular eosinophilic folliculitis. In the past 13 years, a total of 23 cases of EF were diagnosed in our department based on the characteristic clinical and pathological findings. Of these, 16 were non-HIV EF (5 males, 11 females, aged 12-50 yrs, with a mean of 33 yrs), while 7 were HIV-EF (7 males, aged 35-67 yrs, with a mean of 48 yrs). In the non-HIV group, 13 showed clinical pictures of OD, the other 3 had les- sons popular EF lesions similar to HIV-EF. Ten of the 23 EF patients had eosinophilia, and HIV-EF patients had decreased CD4 counts (mean 133/mm3). Microscopically, all EF cases showed eosinophilic folliculitis and perifolliculitis with pilosebaceous pustules or/and microabscess histopatho- logically. Interestingly, 6 cases with OD were associated with follicular mucinosis. Treatments include- ing prednisolone, indomethacin, naproxen,diclofenac, doxycycline, dapsone, ultraviolet B. Fifteen patients were treated with prednisolone and it was effective except 2 HIV-EF. Indomethacin was effect- tive in 4 patients. The rest seemed ineffective. Spontaneous remission was noted in 2 years in about half of the non-HIV patients, but in none of HIV patients. Our study suggests that EF is not rare in Taiwan, and EF should be differentiated from dermatophytosis, rosacea and follicular mucinosis clinically and pathologically.

 

 

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