There are numerous treatment options for wells syndrome eosinophilic cellulitis, including the use of topical corticosteroids, calcineurin inhibitors, griseofulvin, h1 antihistamines, cyclosporine, dapsone, and systemic corticosteroids. Treatment of primary and recurrent cellulitis should initially cover. Wells syndrome, otherwise known as eosinophilic cellulitis, has an unknown etiology. Eosinophilic cellulitis wells syndrome eosinophilic cellulitis is a rare syndrome which may closely mimic bacterial cellulitis or bullous erysipelas. Eosinophilic cellulitis definition of eosinophilic. The inflamed areas can look like a skin infection called cellulitis, but there is no true infection present. The rash comes on suddenly, lasts for a few weeks, and often repeatedly comes back. P28 wells syndrome or eosinophilic cellulitis a case. Eosinophilic pustular folliculitis is often a feature of immunodeficiency. Wells syndrome eosinophilic cellulitis is an acute, recurrent, pruritic dermatitis that is often described as a cellulitislike eruption with edema and eosinophils present in the dermis. It is characterized by development of indurated areas of erythema, usually on a distal limb, which may be single or multiple. She denied fever and other associated symptoms, drug intake, or insect bites.
Papular and nodular eruptions at the clinical presentation have also been reported. Pdf idiopathic bullous eosinophilic cellulitis wells. Eosinophilic cellulitis wells syndrome in a child jama. Wells syndrome in the dog vetgirl veterinary continuing. Eosinophilic cellulitis wells syndrome in association with.
Definition of eosinophilic cellulitis in the dictionary. Microscopically, there is a dense dermal infiltrate of eosinophils. Wells syndrome ws or eosinophilic cellulitis is a rare, idiopathic, inflammatory dermatosis. Wells syndrome eosinophilic cellulitis is an uncommon condition of unknown etiology. This means that eosinophilic cellulitis, or a subtype of eosinophilic cellulitis, affects less than 200,000 people in the us population. Eosinophilic cellulitis primary care dermatology society.
Guideline for the investigation and management of eosinophilia. Wells syndrome, or eosinophilic cellulitis, is a recurrent, hypersensitivity reaction to an arthropod bite, drug, infections, churgstrauss syndrome, or an overlap with hypereosinophilic syndrome. It usually occurs in the loose tissues beneath the skin, but may also occur in tissues beneath. A number of dermatoses come to mind when examining a young patient. Eosinophilic cellulitis wells syndrome is a rare inflammatory skin disease defined by erythematous, tender, sometimes urticarial plaques, possibly with vesicles and bullae, and granulomatous eosinophilic infiltrates in the dermis. As first characterized by wells, and in subsequent reports by wells and smith, and spigel and winkelmann, this eruption was noted to have two phases. The majority of eosinophilic dermatoses lie in the allergyrelated group, including allergic drug eruption, urticaria, allergic contact dermatitis, atopic dermatitis. This topic will discuss the pathogenesis, clinical manifestations, diagnosis, and treatment of ec. Peripheral eosinophilia mild or moderateprofound is present in more than 50%. Eosinophilic cellulitis wells syndrome cutaneous lesions are variable in appearance and may be confused with cellulitis, urticaria, insect bites, or contact dermatitis.
Interferon alfa treatment of a patient with eosinophilic. Cellulitis is an infection of the skin caused by bacteria, usually staphylococcus aureus also called staph and group a beta haemolytic streptococcus. This report describes a rare case of eosinophilic cellulitis in association with angioimmunoblastic lymphadenopathy. A diagnosis of eosinophilic cellulitis ec, or wells syndrome, was made. Eosinophilic cellulitis wells syndrome is a rare disorder characterized clinically by recurrent erythematous plaques resembling cellulitis and histologically by a dermal infiltrate of lymphocytes, eosinophils and eosinophil debris between collagen bundles, forming flame figures in typical cases. Stings by honeybees are not uncommon and most cases cause pain but no significant medical problems. This code is grouped under diagnosis codes for diseases of the skin and subcutaneous tissue. Wells syndrome belongs in diseases with eosinophilic involvement in specific organs eg, skin, lungs. Eosinophilic cellulitis wells syndrome eosinophilic cellulitis is characterized by an intense infiltration of eosinophils, extracellular granule deposition, and flame figures in the dermis. Eosinophilic fasciitis ef is a rare disorder involving chronic inflammation of the fascia and connective tissue surrounding muscles, nerves, and blood vessels.
Do not copy can j plast surg vol 20 no 2 summer 2012 9191 diagnosis and management of eosinophilic cellulitis wells syndrome. A thirtyfiveyearold female presented with 2 weeks history of gradually. We report a 4yearold boy who presented with multiple pruritic, annular, erythematous plaques on the lower extremities of 1 weeks duration. Several treatment modalities have been used to treat eosinophilic cellulitis and have been met with variable success rates. However, other reported cases seem to indicate that eosinophilic cellulitis is not a disease entity as such but, as previously mentioned, represents a hypersensitivity reaction to a variety of stimuli. To our knowledge, eosinophilic cellulitis in a child in whom atrophic alopecia of the affected scalp later develops during the regression phase has not previously been reported. Dermis eosinophilic cellulitis information on the diagnosis. Eosinophilic cellulitis wells syndrome ws is a rare inflammatory. Wells syndrome associated with lung cancer bmj case reports.
Contemporary consensus proposal on criteria and classification of. Information and translations of eosinophilic cellulitis in the most comprehensive dictionary definitions resource on the web. Peripheral blood and bone marrow eosinophilia are usually present. However, bites of spiders, bees, mites, fleas, or ticks arthropods are often associated with this skin condition. It presents with markedly swollen nodules and plaques lumps with prominent borders. Eosinophilic skin diseases, commonly termed as eosinophilic dermatoses, refer to a broad spectrum of skin diseases characterized by eosinophil infiltration andor degranulation in skin lesions, with or without blood eosinophilia. Eosinophilic cellulitis wells syndrome ws is a rare inflammatory skin disorder of unknown etiology. The year 2011 working conference on eosinophil disorders and syndromes was organized to update and refine the criteria and definitions for eosinophilic disorders and to merge prior classifications. Wells syndrome eosinophilic cellulitis is a recurring granulomatous dermatitis with eosinophilia wells, 1971 characterised by i sudden onset annular or circinate erythematous. Recurrent granulomatous dermatitis with eosinophilia.
Mar 26, 2020 there are numerous treatment options for wells syndrome eosinophilic cellulitis, including the use of topical corticosteroids, calcineurin inhibitors, griseofulvin, h1 antihistamines, cyclosporine, dapsone, and systemic corticosteroids. Development of eosinophilic fasciitis during infliximab. Wells first described the disease as recurrent granulomatous dermatitis with eosinophilia. Eosinophilic cellulitis is a rare condition of unknown aetiology, often recurrent and autoremissive. Wells syndrome is a rare eosinophilic disorder that primarily affects the skin. A 26yearold man presented with a history of intermittent erythematous plaques on his hands and legs. Wells syndrome, 1 or eosinophilic cellulitis, first described by wells in 1971 as recurrent granulomatous dermatitis with eosinophilia, 2 is an uncommon inflammatory dermatosis of uncertain pathogenesis characterized by clinical polymorphism, suggestive but nonspecific histopathologic traits, usually a recurrent course, and inconstant response. In october 1994, we initiated therapy with systemic corticosteroids and dapsone, and the patient did well, with two to three swellings per month. Diagnosis and management of eosinophilic cellulitis wells. Eosinophilic cellulitis wells syndrome successfully. Eosinophilic cellulitis wells syndrome, international.
Pdf bullous eosinophilic cellulitis succession with. Eosinophilic cellulitis wells syndrome is a rare inflammatory skin disease defined by erythematous, tender, sometimes urticarial plaques, possibly with vesicles and bullae, and granulomatous. Eosinophilic cellulitis wells syndrome ws is a rare in. We present here a case of a 59yearold male who developed peripheral eosinophilia and subsequent eosinophilic.
Eosinophilic cellulitis wells syndrome sara almutlaga, saudi board, arab board of medical specialization in dermatology eosinophilic cellulitis wells syndrome is an uncommon inflammatory disease with clinical polymorphism. Eosinophilic cellulitis wells syndrome in association. Recurrent cutaneous necrotizing eosinophilic vasculitis. Eosinophilic cellulitis wells syndrome as a cutaneous. Good syndrome, goods syndrome, immunodeficiency with thymoma, thymoma with immunodeficiency, wells syndrome. Affected people typically develop a skin rash that is often preceded by itching or burning skin.
Bullous pesentation of idiopathic wells syndrome eosinophilic cellulitis dear editor, a 44yearold female presented with pruritic oedematous papules and plaques with vesiculobullae formation over her face, trunk and limbs over 1 week fig. The patches are usually bright red at first, frequently looking like cellulitis, then fade over four to eight weeks, leaving green. Eosinophilic cellulitis wells syndrome successfully treated. It is often associated with infectious, allergic or myeloproliferative diseases. The typical clinical presentation is urticarial plaque without preferential location that usually heals without scarring. Cellulitis caused by honeybee sting is very rare and can be a late complication in some patients. The rash consists of raised, red, swollen areas that may be warm to the touch. Eosinophilic cellulitis wells syndrome is an inflammatory dermatitis that is often misdiagnosed as infectious cellulitis due to its similarity in presentation. Mar 12, 2020 cellulitis is an infection of the skin and deep underlying tissues. Eosinophilic cellulitis wells syndrome successfully treated with. Eosinophilic cellulitis wells syndrome is a rare disorder characterized clinically by recurrent erythematous plaques resembling cellulitis and histologically by a dermal infiltrate of lymphocytes, eosinophils and eosinophil debris between collagen bundles, forming flame. The nursing care for patients with dermatitis involves treatment for atopic lesions consisting of eliminating all allergens and avoiding irritants, extreme temperatures, and humidity changes, and other factors. Usually the disease has a benign course with spontaneous remission within a. Less common but reported presentations also include nodules, vesicles, bullae, and urticaria.
Pdf eosinophilic cellulitis in a patient with gastric cancer. Eosinophilic cellulitis is listed as a rare disease by the office of rare diseases ord of the national institutes of health nih. Wells syndrome eosinophilic cellulitis is usually diagnosed on the basis of the characteristic histopathologic findings in a skin biopsy specimen. The bacteria enter your body when you get an injury such as a bruise, burn, surgical cut, or wound. Wells syndrome, or eosinophilic cellulitis, is a rare, recurrent, inflammatory dermatosis of unknown pathogenesis. The presentation usually involves a mildly pruritic or tender cellulitis like eruption with typical histologic features characterized by edema, flame figures, and a marked infiltrate of eosinophils in the dermis. Wells syndrome, or eosinophilic cellulitis, is a rare disorder characterized by erythematous plaques evolving into dermal or subcutaneous masses. We report two adult male patients who had recurrent erythematous plaques and a nodular lesion on the abdomen. Group a strep streptococcal bacteria are the most common cause. Eosinophilic cellulitis, or wells syndrome, was first described in 1971 as a granulomatous dermatitis.
The skin lesions of wells syndrome are distinguished from those of bacterial cellulitis by the absence of tenderness and the presence of pruritus, which is often the primary symptom of wells syndrome. Wells syndrome is a rare disease which also goes by the name eosinophilic cellulitis. It is characterized by raised, red, swollen, and warm areas of skin, in a flameshaped pattern with associated pain. Wells syndrome or eosinophilic cellulitis ec was initially described by george wells in 1971 in 4 patients who demonstrated pruritic, erythematous to violaceous papules, plaques, and occasionally bullae in 1 or more locations. Eosinophilic cellulitis wells syndrome is an uncommon inflammatory disease with clinical polymorphism. While its pathogenesis is not entirely understood, this disorder is thought to be autoimmune or allergic in nature. Since wells and smith first described cases of eosinophilic cellulitis wells syndrome. We present a 62yearold man with history of lung cancer that had undergone a right superior lobectomy 12 months previously.
We describe here a previously healthy 11yearold girl who experienced fever and tender erythematous patch lesions after. In people, the presentation usually involves a mildly pruritic or tender cellulitis like eruption with typical histologic features characterized by edema, flame figures, and a marked infiltrate of eosinophils in the dermis. Eosinophilic cellulitis an overview sciencedirect topics. Review articles mechanisms of disease columbia university.
Similar histological appearances can be seen in other dermatological conditions but these can often be. Eosinophilic cellulitis is a rare condition characterized by recurrent pruritic or tender skin lesions. Treatment of recalcitrant eosinophilic cellulitis with. Misdiagnosis leads to delay of correct treatment and inappropriate use of antibiotics. Familial eosinophilic cellulitis is a rare skin disorder. Eosinophilic cellulitis wells syndrome associated with colon carcinoma.
Wells syndrome genetic and rare diseases information. Eosinophilic cellulitis is a rare condition of unknown cause. Although most cases of wells syndrome occur in adults, we present a child with these clinical and histopathologic findings. Source national institute of health detailed list of causes of. Treatment with systemic corticosteroids was administered for 1. May be idiopathic, associated with drugs, or even associated with myeloproliferative, immunological or infectious diseases. Wells syndrome eosinophilic cellulitis is a recurring granulomatous dermatitis with eosinophilia wells 1971 characterised by i sudden onset annular or circinate erythematousoedematous patches that rapidly evolve to morphoealike slateblue plaques, ii a histological appearance characterized by the presence of flame figures and. Ws in 1979, it has been noted that some but not all. Eosinophilic pustular folliculitis is also a rare inflammatory dermatosis characterized by recurrent crops of erythematous.
Eosinophilic cellulitis, also known as wells syndrome, is a skin disease that presents with painful, red, raised, and warm patches of skin. Treatment of eosinophilic cellulitis wells syndrome a. Eosinophilic cellulitis typically responds well to systemic steroids. Eosinophilic cellulitis primary care dermatology society uk. Eosinophilic cellulitis is a very rare condition that was first described in 1971 by george wells.
We report a case of recurrent cutaneous necrotizing eosinophilic vasculitis. Eosinophilic cellulitis ec is a rare idiopathic disorder, first described as a recurrent granulomatous dermatitis with eosinophilia, that mimics cellu litis of infectious origin. Eosinophilic cellulitislike reaction to subcutaneous. Often clinically resembles cellulitis, hence its other name eosinophilic cellulitis. Eosinophilic pustular folliculitis associated with hiv infection presents when levels of cd4 lymphocyte cells drop below 300 cellsmm 3, a level at which there is an increased risk of a secondary opportunistic infection. The presentation usually involves a cellulitis like eruption, although papular, nodular and bullous eruptions have been reported. Eosinophilic cellulitis wells syndrome successfully treated with lowdose cyclosporine eosinophilic cellulitis wellssyndrome is an uncommon skin disorder. Granulomatous dermatitis with eosinophilia wells syndrome occurred in an 11yearold boy. Present eosinophilic pneumonitis, asthma gastrointestinal present or absent present inflammatory bowel disease, eosinophilic gastroenteritis, allergic colitis allergic present or absent present allergic rhinoconjunctivitis, asthma, eczema systemic present present idiopathic hypereosinophilic syndrome, vasculitis iatrogenic present present or absent.
Pdf eosinophilia and hypereosinophilic disorders update on. Wells syndrome, also known as eosinophilic cellulitis, is a rare condition that was first described in 1971 as a recurrent granulomatous dermatitis with eosinophilia. Biopsies usually display characteristic histologic features of dermal edema, eosinophils, and flame figures collections of degranulated eosinophilic material. Successful treatment of steroiddependent eosinophilic. It resolves spontaneously, leaving a granulomatous infiltration.
Some patients, however, have lethal complications such as acute anaphylactic shock. Idiopathic bullous eosinophilic cellulitis wells syndrome. Most clinicians are familiar with more common presentations such as demodicosis, dermatophytosis, and superficial bacterial infections, but the following highlighted disorders may not be foremost in mind when formulating a list of differentials. Eosinophilic gastroenteritis definition of eosinophilic. In this disease, itchy, burning, red, and inflamed areas can form anywhere on the skin. Eosinophilic cellulitis has been regarded by some authors4 as a distinct disease belonging t the eosinophilic syndromes involving skin. Eosinophilic cellulitis wells syndrome in a pediatric. However, bites of spiders, bees, mites, fleas, or ticks arthropods are often.
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