Eosinophilic Cellulitis

 

Eosinophilic cellulitis, also known as Well's syndrome, is a rare inflammatory skin disorder of unknown etiology.  Its categorized as a relapsing eosinophilic dermatitis with variable clinical appearance. Cutaneous lesions are variable in appearance and may be similar to cellulitis, urticaria, insect bites, morphea or contact dermatitis. During the acute phase the child develops tender urticarial plaques, vesicles, bullae or nodules in the skin. This is usually accompanied with peripheral blood eosinophilia. Papulovesicular blistering and nodular lesions which are often painful or pruritic can also be seen. Later the skin lesions become indurated with morphealike appearance resolving without significant scarring. Histopathologic findings of the lesion include eosinophilic granulomatous infiltration of the dermis and formation of flame figures without signs of vasculitis. Hypersensitivity due to different triggers such as insect bites, or stings, drugs, infections, atopic dermatitis and contact dermatitis have been proposed. Causative medications include antibiotics, anticholinergic agents, anesthetics, non-steroidal anti-inflammatory agents, thyroid medications, chemotherapeutic agents, thiomersal containing vaccination, anti-tumor necrosis factor agents and thiazide diuretics. Children with sensitivity to thiomersal found in certain vaccines (such as influenza) can develop eosinophilic cellulitis. Diagnosis of the condition might need biopsy for histopathological identification. Other times the lesions coalesces and cause a subcutaneous abscess which need to be drained. Well's syndrome is initially managed successfully with topical or systemic corticosteroids and calcineurin inhibitors but it often relapse upon tapering. Systemic glucocorticosteroid are the most common and effective treatment modality reported.   

References:
1- Herout S, Bauer WM, Schuster C, Stingl G: Eosinophilic cellulitis (Wells syndrome) successfully treated with mepolizumab. JAAD Case Rep. 4(6):548-550, 2018
2- Kucharczyk M, Slowik-Rylska M, Krecisz B: Insect bites as a trigger factor of eosinophilic cellulitis. Ann Agric Environ Med. 26(2):256-259, 2019
3- Safran T, Masckauchan M, Maj J, Green L: Wells syndrome secondary to influenza vaccination: A case report and review of the literature. Hum Vaccin Immunother. 14(4):958-960, 2018
4- Yu AM, Ito S, Leibson T, Lavi S, Fu LW, Weinstein M, Skotnicki SM: Pediatric Wells syndrome (eosinophilic cellulitis) after vaccination: A case report and review of the literature. Pediatr Dermatol. 35(5):e262-e264, 2018
5- Ogueta I, Spertino J, Deza G, et al: Wells syndrome and chronic spontaneous urticaria: report of four cases successfully treated with omalizumab. J Eur Acad Dermatol Venereol. 2019 May 20. doi: 10.1111/jdv.15683. [Epub ahead of print].
6- Dabas G, De D, Handa S, Chatterjee D, Radotra BD: Wells syndrome in a patient receiving adalimumab biosimilar: A case report and review of literature. Indian J Dermatol Venereol Leprol. 84(5):594-599, 2018
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