Eosinophilic cellulitis

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Eosinophilic cellulitis
Other namesWells' syndrome, recurrent granulomatous dermatitis with eosinophilia [1]
SkinInEosinCell.jpg
Initial rash in eosinophilic cellulitis
Specialty Dermatology
Symptoms Painful, red, raised, warm patches of skin, fever, joint pain [2]
Usual onsetSudden and recurrent [2]
DurationFew weeks [2]
CausesUnknown [2]
Differential diagnosis Vasculitis, cellulitis, anaphylaxis [2] [1]
Medication Corticosteroids, antihistamines [2] [1]
Prognosis Often goes away by itself [2]
Frequency~200 documented cases [1]

Eosinophilic cellulitis, also known as Wells' syndrome (not to be confused with Weil's disease), is a skin disease that presents with painful, red, raised, and warm patches of skin. [2] The rash comes on suddenly, lasts for a few weeks, and often repeatedly comes back. [2] Scar formation does not typically occur. [1]

Contents

Eosinophilic cellulitis is of unknown cause. [2] It is suspected to be an autoimmune disorder. [2] It may be triggered by bites from insects and arachnids such as spiders, fleas, or ticks, or from medications or surgery. [2] Diagnosis is made after other potential cases are ruled out. [1] Skin biopsy of the affected areas may show an increased number of eosinophils. [2] Other conditions that may appear similar include cellulitis, contact dermatitis, and severe allergic reactions such as anaphylaxis. [2]

Treatment is often with a corticosteroids. [2] Steroids applied as a cream is generally recommended over the use of steroids by mouth. [3] Antihistamines may be used to help with itchiness. [1] Many times the condition goes away after a few weeks without treatment. [2] The condition is uncommon. [1] It affects both sexes with the same frequency. [2] It was first described by George Crichton Wells in 1971. [1] [4]

Cause

Eosinophilic cellulitis is of unknown cause. [2] It is suspected to be an autoimmune disorder. [2] It may be triggered by bites from insects such as mosquitos, [5] spiders, fleas, or ticks, or from medications or surgery. [2]

Diagnosis

Histology of a skin biopsy from acute phase eosinophilic cellulitis. Note findings of plentiful tissue eosinophils and flame figures at the deeper corium sections (hematoxylin & eosin, original magnification x40). HistEosinCell.jpg
Histology of a skin biopsy from acute phase eosinophilic cellulitis. Note findings of plentiful tissue eosinophils and flame figures at the deeper corium sections (hematoxylin & eosin, original magnification ×40).

Diagnosis requires ruling out other potential causes. [1] This includes ruling out vasculitis on skin biopsy. [1]

Treatment

Treatment is often with a steroids. [2] This can be either applied as a cream or taken by mouth. [3] As the condition tends to get better on its own taking steroids by mouth should generally only be tried if the rash covers a large area and it does not get better with other measures. [3]

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References

  1. 1 2 3 4 5 6 7 8 9 10 11 Weins, AB; Biedermann, T; Weiss, T; Weiss, JM (October 2016). "Wells syndrome". Journal der Deutschen Dermatologischen Gesellschaft. 14 (10): 989–993. doi: 10.1111/ddg.13132 . PMID   27767278.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 "Familial Eosinophilic Cellulitis - NORD (National Organization for Rare Disorders)". NORD (National Organization for Rare Disorders). 2009. Retrieved 10 April 2017.
  3. 1 2 3 Räßler, F; Lukács, J; Elsner, P (September 2016). "Treatment of eosinophilic cellulitis (Wells syndrome) - a systematic review". Journal of the European Academy of Dermatology and Venereology. 30 (9): 1465–79. doi:10.1111/jdv.13706. PMID   27357601. S2CID   206043169.
  4. Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN   978-1-4160-2999-1.
  5. Tatsuno K, Fujiyama T, Matsuoka H, Shimauchi T, Ito T, Tokura Y (June 2016). "Clinical categories of exaggerated skin reactions to mosquito bites and their pathophysiology". Journal of Dermatological Science. 82 (3): 145–52. doi:10.1016/j.jdermsci.2016.04.010. PMID   27177994.