LAUSR

To the Editor: A 64‐year‐old Chinese man had a 12‐month history of nonmetastatic primary scalp angiosarcoma [Figure 1a] that had been confirmed by skin biopsy [Figure 1e]. Immunohistochemical examination showed CD31‐, CD34‐, and D2‐40‐positive tumor cells [Figure 1f–1h]. Extensive local excision and placement of a free skin graft was performed in December 2016. The patient declined postsurgical treatments including chemotherapy, radiotherapy, and immunosuppressive drugs. Two months later, he was referred to us with pruritic red eruptions on his cheeks and scalp. The lesions gradually increased in size and number and became pruritic. Physical examination revealed multiple follicular papules and pustules on his scalp and cheeks, forming an annular configuration on the face [Figure 1b]. The total leukocyte count was 6150/μl, with 24.4% lymphocytes (1500/μl) and 22.6% eosinophils (1390/μl). Serological tests were negative for human immunodeficiency virus (HIV), hepatitis B and C, syphilis, serum immunoglobulins, and antinuclear antibodies. The results of brain magnetic resonance imaging and thoraco‐abdominal computed tomography were unremarkable. Excisional biopsies from the cheek and scalp showed predominantly intense infiltration of eosinophils, neutrophils, and lymphocytes in the pilosebaceous unit [Figure 1d] and around the blood vessels. Based on these findings, a diagnosis of eosinophilic pustular folliculitis (EPF) was made. He was then treated with oral prednisone at 30 mg/d. The treatment resulted in prompt remission of the EPF [Figure 1c]. The prednisone dosage was then gradually tapered. The skin eruptions on the face recurred when the prednisone dosage was tapered to 5 mg/d. After the dosage was increased to 30 mg/d again, the skin lesions markedly improved. The patient is still undergoing follow‐up at our clinic.