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. The oedematous erysipelas or urticarialike plaques of eosinophilic cellulitis appear acutely and later develop into morphealike, slate blue colored indurations, fading slowly over weeks to months 1, 2. In this disease, itchy, burning, red, and inflamed areas can form anywhere on the skin. Grossly it appears as single or multiple erythematous, edematous plaques and histologically demonstrates an intense eosinophilic infiltrate with an edematous dermis, which later is infiltrated by. Pdf eosinophilic cellulitis in a patient with gastric cancer.
David weedon ao md frcpa fcaphon, in weedons skin pathology third edition, 2010. Eosinophilic cellulitis an overview sciencedirect topics. Frontiers eosinophils in autoimmune diseases immunology. Wells syndrome, also known as eosinophilic cellulitis, is a rare condition that was first described in 1971 as a recurrent granulomatous dermatitis with eosinophilia. It sometimes occurs as an exaggerated response to bites of spiders, bees, fleas, ticks, or mites arthropods, or it may have other causes such as surgery or drugs. Two pediatric cases with positive patch test to aluminium salts. Eosinophilic cellulitis as a result of onchocerciasis eosinophilic cellulitis as a result of onchocerciasis hoogenband, h. In people, the presentation usually involves a mildly pruritic or tender cellulitislike eruption with typical histologic features characterized by edema, flame figures, and a marked infiltrate of eosinophils in the dermis. It is often associated with infectious, allergic or myeloproliferative diseases. Jan 23, 2017 wells syndrome eosinophilic cellulitis is a recurring granulomatous dermatitis with eosinophilia wells, 1971 characterised by i sudden onset annular or circinate erythematous. Wells syndrome belongs in diseases with eosinophilic involvement in specific organs eg, skin, lungs.
Eosinophilic cellulitis wells syndrome jama dermatology. The rash comes on suddenly, lasts for a few weeks, and often repeatedly comes back. A rare eosinophilic dermatosis, wells syndrome, also referred to as eosinophilic cellulitis, is characterized by great clinical variability. Migratory erythema and eosinophilic cellulitis associated. Ec is characterized clinically by pruritic, erythematous plaques resembling infectious cellulitis and histologically by the presence of edema, infiltration of eosinophils, and flame figures in the dermis. Wells syndrome and its relationship to churgstrauss syndrome. The inflamed areas can look like a skin infection called cellulitis, but there is no true infection present. Eosinophilic cellulitis wells syndrome ws is a rare inflammatory skin disorder of unknown etiology. Eosinophilic cellulitis ec, or wellssyndrome, was first described by wells in 1971 1. Eosinophilic cellulitis wells syndrome in association with. Wells first described the disease as recurrent granulomatous dermatitis with eosinophilia. Diagnosis and management of eosinophilic cellulitis wells. Eosinophilic cellulitis, also known as wells syndrome not to be confused with weils disease, is a skin disease that presents with painful, red, raised, and warm patches of skin. Wells syndrome eosinophilic cellulitis following vaccination.
Eosinophilic cellulitis wellssyndrome, international. To report a case of wells syndrome eosinophilic cellulitis in a patient. It sometimes occurs as an exaggerated response to bites of spiders, bees, fleas, ticks, or mites arthropods. Often clinically resembles cellulitis, hence its other name eosinophilic cellulitis. Get a printable copy pdf file of the complete article 673k, or click on a page image below to browse page by page.
Eosinophilic cellulitis wells syndrome fisher 1985. Although a distinct entity, it has been suggested that wells syndrome may be associated with rare multisystem eosinophilic disorders, such as churgstrauss syndrome and hypereosinophilic syndrome. Treatment of eosinophilic cellulitis wells syndrome a. Abstract eosinophilic cellulitis wells syndrome is a rare inflammatory skin disease defined by erythematous, tender, sometimes urticarial.
Several treatment modalities have been used to treat eosinophilic cellulitis and have been met with variable success rates. The presentation usually involves a cellulitis like eruption, although papular, nodular and bullous eruptions have been reported. Get a printable copy pdf file of the complete article 865k, or click on a page image below to browse page by page. Ec is an idiopathic rare disorder representing wellcircumscribed erythematous plaques with variable appearances, for instances, papulovesicular, blistering and nodular lesions. Eosinophilic cellulitis is a rare condition of unknown cause. This report describes a rare case of eosinophilic cellulitis in association with angioimmunoblastic lymphadenopathy. It is an inflammatory reaction to some type of antigen that causes a reaction that mimics cellulitis. Eosinophilic cellulitis ec, also known as wells syndrome, is a rare idiopathic, painful or pruritic, noninfectious type of cellulitis of unknown p. Eosinophilic cellulitis wells syndrome in a child jama. Wells syndrome eosinophilic cellulitis dermatology advisor. We report two adult male patients who had recurrent erythematous plaques and a nodular lesion on the abdomen. Clinically, there are edematous infiltrated plaques.
Pdf a 55yearold woman presented with a 3year history of recurrent episodes of pruritic cellulitislike erythematous plaques, mostly located. In both cases there is strong evidence that it must be regarded as a reaction to onchocerciasis. In 1971 wells described an unusual cutaneous eruption resembling acute cellulitis. Another patient group with features resembling eosinophilic myositis are the systemic autoimmune disorders. 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. It presents with markedly swollen nodules and plaques lumps with prominent borders. Peripheral eosinophilia mild or moderateprofound is present in more than 50%. Wells st thomas hospital, lambeth palace road, london se17eh and st johns hospital for diseases of the skin, lisle street, leicester square, london wc2h 7bj. Recurrent cutaneous necrotizing eosinophilic vasculitis. Nov 28, 2008 eosinophilic cellulitis wells syndrome is a polyetiologic clinical entity with still obscure pathogenesis.
Familial eosinophilic cellulitis is a rare skin disorder. Eosinophilic cellulitis wells syndrome successfully treated. Wells syndrome eosinophilic cellulitis is a recurring granulomatous dermatitis with eosinophilia wells, 1971 characterised by i sudden onset annular or circinate erythematous. The icd10 can also be downloaded in pdf form examples of conditions captured using codes from chapter xii. This topic will discuss the pathogenesis, clinical manifestations, diagnosis, and treatment of ec. Eosinophilic cellulitis ec is a rare inflammatory skin disorder of unknown etiology first described by wells in 1971 as recurrent granulomatous dermatitis with eosinophilia. Treatment of eosinophilic cellulitis wells syndromea systematic. These bacteria live on the skin and may enter an area of broken skin like a cut or scratch and cause an infection in the tissue under the skin.
Eosinophilic cellulitis wells syndrome is an established, polyetiologic clinical entity with still obscure pathogenesis. Wells syndrome, or eosinophilic cellulitis, is a recurrent, hypersensitivity reaction to an arthropod bite, drug, infections, churgstrauss syndrome, or an overlap with hypereosinophilic syndrome. Wells syndrome, otherwise known as eosinophilic cellulitis, has an unknown etiology. Wells syndrome is a rare disease which also goes by the name eosinophilic cellulitis. 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. Eosinophilic cellulitis caused by arthropod bites eosinophilic cellulitis caused by arthropod bites clark, david p anderson, philip c. Eosinophilic cellulitis wells syndrome is an inflammatory dermatitis that is often misdiagnosed as infectious cellulitis due to its similarity in presentation. A case report of a 26yearoldwoman with an 18month history of wells syndrome treated successfully with dapsone 200mg per day for 2 weeks. Eosinophilic cellulitis as a manifestation of onchocerciasis. Successful treatment of eosinophilic cellulitis with dapsone article pdf available in dermatology online journal 227. Microscopically, there is a dense dermal infiltrate of eosinophils. Eosinophilic cellulitis wells syndrome in association.
Eosinophilic cellulitis wells syndrome successfully. Prognosis for wells syndrome is excellent and most patients recover without difficulty, although lesions may recur later. Misdiagnosis leads to delay of correct treatment and inappropriate use of antibiotics. Eosinophilic cellulitis is a very rare condition that was first described in 1971 by george wells. Idiopathic bullous eosinophilic cellulitis wells syndrome responsive to topical tacrolimus and antihistamine combination prashant verma 1, archana singal 1, sonal sharma 2 1 department of dermatology and std, university college of medical sciences university of delhi and guru teg bahadur hospital, delhi university, delhi, india 2 department of pathology, university college of medical. Two months after initiation of mepolizumab treatment, lesions had. This means that eosinophilic cellulitis, or a subtype of eosinophilic cellulitis, affects less than 200,000 people in the us population. Background eosinophilic cellulitis wells syndrome is a polyetiologic clinical entity with still obscure pathogenesis. Eosinophilic cellulitis in a patient with gastric cancer article pdf available in acta dermatovenereologica 896. Eosinophilic cellulitis wells syndrome is a very rare skin disease characterized by recurrent edematous erythema. Bullous eosinophilic cellulitis wells syndrome associated with churgstrauss syndrome. Wells syndrome in the dog vetgirl veterinary continuing. Idiopathic bullous eosinophilic cellulitis wells syndrome.
Clinically overt toxocariasis is uncommon in adults, yet helminthozoonoses, including toxocariasis have been occasionally implicated in the pathogenesis of eosinophilic cellulitis. Eosinophilic polymyositis has a broad differential diagnosis and it is of paramount importance to rule out infectious diseases, since administration of glucocorticoids or immunosuppressive drugs to patients with an infectious process could result in a dramatically bad outcome. Pdf successful treatment of eosinophilic cellulitis with. Eosinophilic cellulitis and dermographism nathalie q nguyen md and linglei ma md phd dermatology online journal 11 4. Eosinophilic cellulitis primary care dermatology society uk.
Eosinophilic cellulitis definition of eosinophilic. Wells syndrome eosinophilic cellulitis secondary to. Mar 26, 2020 wells syndrome eosinophilic cellulitis. For information about coding and financial assistance for patients, please contact. Eosinophilic cellulitis wells syndrome successfully treated with lowdose cyclosporine eosinophilic cellulitis wellssyndrome is an uncommon skin disorder. All versions of the icd10, including the most recent one 2019, can be browsed freely on the website of the world health organisation who. 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. It usually occurs in the loose tissues beneath the skin, but may also occur in tissues beneath.
Granulomatous dermatitis with eosinophilia wells syndrome occurred in an 11yearold boy. This is a shortened version of the twelfth chapter of the icd10. A 26yearold man presented with a history of intermittent erythematous plaques on his hands and legs. A thirtyfiveyearold female presented with 2 weeks history of gradually progressive and painful erythematous plaque on the right foot.
Steven brown, university of pittsburgh school of medicine answered may. Guideline for the investigation and management of eosinophilia. Eosinophilic cellulitis has been regarded by some authors4 as a distinct disease belonging t the eosinophilic syndromes involving skin. Full text full text is available as a scanned copy of the original print version. Pdf successful treatment of eosinophilic cellulitis with dapsone. Eosinophilic cellulitis wells syndrome ws is a rare inflammatory skin. Eosinophilic cellulitis primary care dermatology society. Eosinophilic cellulitis wells syndrome is a rare inflammatory skin disease defined by erythematous, tender, sometimes urticarial plaques, possibly. The patches are usually bright red at first, frequently looking like cellulitis, then fade over four to eight weeks, leaving green, grey or brown patches. Wells syndrome eosinophilic cellulitis wells syndrome eosinophilic cellulitis 2327 is a disorder of unknown pathogenesis characterized by the tissue reaction pattern known as eosinophilic cellulitis with flame figures see p. Eosinophilic cellulitis wells 1979 british journal. Eosinophilic cellulitis wells syndrome successfully treated with. 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.
Here are links to possibly useful sources of information about eosinophilic cellulitis. Cutaneous lesions are variable in appearance and may be confused with cellulitis, urticaria, insect bites, or contact dermatitis. Eosinophilic cellulitis is a rare condition first described in 1971 as recurrent granulomatous dermatitis with eosinophilia. To best navigate the list, first download this pdf file to your computer. P28 wells syndrome or eosinophilic cellulitis a case. Eosinophilic cellulitis wells syndrome eosinophilic cellulitis is a rare syndrome which may closely mimic bacterial cellulitis or bullous erysipelas. Eosinophilic cellulitis wells syndrome is an uncommon inflammatory disease with clinical polymorphism.
It is characterized by development of indurated areas of erythema, usually on a distal limb, which may be single or multiple. All structured data from the file and property namespaces is available under the creative commons cc0 license. A thirtyfiveyearold female presented with 2 weeks history of gradually. A 55yearold female patient presented with a skin biopsy verified recurring febrile eosinophilic.
Introduction eosinophilic cellulitis wells syndrome ws is a rare in. Eosinophilic cellulitis a response to treatment with dapsone. The typical histopathological sign is flame figures, the focal accumulation. Eosinophilic cellulitis wells syndrome caused by a temporary henna tattoo article pdf available in postepy dermatologii i alergologii 315. Pdf wells syndrome or eosinophilic cellulitis is characterized clinically by an acute. Pdf eosinophilic cellulitis wells syndrome caused by a.
The presentation usually involves a cellulitislike eruption, although papular, nodular and bullous eruptions have been reported. Usually the disease has a benign course with spontaneous remission within a few weeks. Eosinophilic cellulitis is listed as a rare disease by the office of rare diseases ord of the national institutes of health nih. Files are available under licenses specified on their description page. Eosinophilic cellulitis is potentially associated with egpa, hes, uc, or other causes, but the etiology is unknown 274, 275.
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