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