Skin nontumor

• Idiopathic inflammatory dermatitis with eosinophilic infiltration
• Also known as eosinophilic cellulitis

• Clinical picture is variable but most often recurrent bouts of edematous nodules and plaques, often preceded by prodromal itching or pain
• Usually a limited course over weeks to month but often recur
• May resemble cellulitis clinically but not warm or tender (Postepy Dermatol Alergol 2014;31:322) and does not improve with antibiotics (J Clin Aesthet Dermatol 2011;4:55)
• Erythematous papules, plaques or nodules that may be painful or pruritic (Postepy Dermatol Alergol 2014;31:322)
• Sometimes annular configuration, can blister
• May be single or multiple
• Peripheral blood eosinophilia common (found in 67% of cases) (Can J Plast Surg 2012;20:91)
• Leukocytosis (found in 41% of cases)

• Oral or topical corticosteroids most commonly, often with dramatic improvement
• Antihistamines and immunomodulatory agents also used for refractory or unresponsive cases

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Contributed by Favia Dubyk, M.S., M.D.


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• Bacterial cellulitis: dermal to subcutaneous infiltrate of neutrophils, often with superficial dermal edema; typically lacks flame figures and neutrophils predominate over eosinophils
• Churg-Strauss syndrome: may have similar eosinophilic granulomas, vasculitis not always present in skin biopsy, clinical correlation helpful

Eosinophilic annular erythema: has features of Wells syndrome as well as dermal mucin, vacuolar interface change

Flame figures are rarely seen in allergic contact dermatitis, arthropod bite reaction, bullous pemphigoid, dermatophyte infection, drug reaction, herpes gestationis; correlation with clinical findings is needed

Parasite infestation: can appear identical to Wells syndrome; in areas with endemic parasite infections, lesions resembling Wells syndrome are more often related to an underlying parasite infection

Which of the following statements is true of Wells syndrome?

1. Flame figures are pathognomonic
2. Granulomatous inflammation always absent
3. Lesions can clinically resemble cellulitis
4. Peripheral blood eosinophilia is required for diagnosis
5. Vasculitis usually present

C. Often clinically resembles cellulitis, hence it's other name eosinophilic cellulitis. Answer A is incorrect because while flame figures are a hallmark of the disease, these can sometimes be seen in a number of other settings such parasite infestation, arthropod bite, drug reaction, allergic contact dermatitis and bullous pemphigoid. Answer B is incorrect because older lesions can have a granulomatous component, sometimes with prominent giant cells. Answer D is incorrect because this is seen in up to 67% of patients but not required for diagnosis. Answer E is inocrrect because vasculitis is typically absent although there may be extravasated erythrocytes.

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Reference: Wells syndrome