Clinical Features and Treatment of Eosinophilic Pustular Folliculitis in Childhood: A Systematic Review and Single-Arm Meta-Analysis.

BACKGROUND

Eosinophilic pustular folliculitis (EPF) is a rare, noninfectious eosinophilic inflammatory disease that manifests with papulopustular lesions. Although EPF is not a severe skin disorder, it is recurring and causes uncomfortable symptoms, such as itching, that impact the patient's quality of life.

METHODS

The Embase, PubMed, Web of Science, and Cochrane databases were systematically searched for studies on children with EPF up to May 2025. The study was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A restricted maximum likelihood (REML) random-effects model was performed for all endpoints to synthesize results with a 95% confidence interval (CI). Cochran's Q test and I2 were used to assess heterogeneity. R version 4.2.2 was used for statistical analysis.

RESULTS

52 studies comprising 136 patients with EPF were included. The analysis showed a mean age of 11.16 months (95% CI: 5.11-17.22) and a male predominance of 80.58% (95% CI: 71.60-88.20). Scalp lesions were the most common site with a rate of 92.10% (95% CI: 71.25-100.00). The most common treatment included topical hydrocortisone at 1.48% (95% CI: 0.00-8.51), corticoid not identified (NI) at 2.00% (95% CI: 0.00-9.42), and others at 6.17% (95% CI: 0.00-24.16).

CONCLUSIONS

This systematic review and meta-analysis showed that EPF in childhood primarily affects male patients, with patient ages ranging from 0.03 to 192 months. The lesion's most frequent location is the scalp. Corticosteroids were identified as the primary treatment strategy.