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Dermatologic Manifestations of Eosinophilic Fasciitis Treatment & Management

  • Author: Brad S Graham, MD; Chief Editor: William D James, MD  more...
Updated: Sep 14, 2015

Medical Care

Many eosinophilic fasciitis cases respond to corticosteroids (88%, with 25% obtaining complete recovery), although spontaneous resolution is possible. Complete recovery may take up to 1-3 years. No consensus on the treatment of eosinophilic fasciitis exists, but most studies indicate that the best response is with moderate-to-high doses of corticosteroids, especially if started early in the disease course. No set dosing schedule is available, but most studies advocate doses of 0.5-1 mg/kg/d until response, with rapid tapering to alternate day therapy.

Several eosinophilic fasciitis cases exist in the literature of recalcitrant disease to corticosteroids in which adjunctive therapy may be required.

Adjunctive medications for eosinophilic fasciitis include hydroxychloroquine, colchicine, cimetidine, cyclosporin,[17] azathioprine, and methotrexate. A more recent study looked at extracorporal photochemotherapy in the treatment of corticosteroid-resistant cases. After 1 year of therapy, 2 of 3 patients showed considerable improvement when combined with low-dose corticosteroids.[18]

Newer therapies that have been used as corticosteroid adjuncts or as monotherapy for eosinophilic fasciitis include infliximab,[19] cyclophosphamide,[20] dapsone,[21] retinoid-UVA1,[22] and oral psoralen plus UVA (PUVA).[23]

In a promising follow-up report on 3 cases of steroid-resistant eosinophilic fasciitis, all patients showed improvement in skin induration and joint contractures with infliximab at 3 mg/kg every 8 weeks. All patients were in remission in 1-3 years.[24]

A single case report in 2009 reported the use of intravenous immunoglobulin to treat eosinophilic fasciitis.[25]

In a large series of 34 patients with eosinophilic fasciitis, corticosteroids was the standard first-line therapy. In this series, 44% of patients received a second-line therapy adjunctive immunosuppressant, usually methotrexate. The highest chance of complete remission was in patients treated with pulse methylprednisolone at the earliest onset of diagnosis. This also minimized the need for additional immunosuppressive drugs.[26]

A case report in 2102 documented 2 patients with corticosteroid-refractory eosinophilic fasciitis who were successfully treated with D-penicillamine.[27]

A case report in 2015 described a relapse post corticosteroid treatment, which became steroid-resistant and refractory to methotrexate and anti-tumor necrosis factor agent treatment. This patient had a rapid response with sustained remission to the anti-interleukin 6 agent, tocilizumab.[28]


Surgical Care

Surgical decompression of carpal tunnel syndrome may be required for eosinophilic fasciitis.



A physical therapist may be consulted. Active and passive range of motion therapy of the involved extremities and joints is crucial along with medical therapy to prevent and to treat joint contractures.

Contributor Information and Disclosures

Brad S Graham, MD Consulting Staff, Dermatology Associates of Tyler

Brad S Graham, MD is a member of the following medical societies: Alpha Omega Alpha, Texas Dermatological Society, American Academy of Dermatology, American Society of Dermatopathology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Ponciano D Cruz, Jr, MD Professor and Vice-Chair, Paul R Bergstresser Chair, Department of Dermatology, University of Texas Southwestern Medical Center

Ponciano D Cruz, Jr, MD is a member of the following medical societies: Texas Medical Association

Disclosure: Received consulting fee from RCTS for independent contractor; Received honoraria from Mary Kay Cosmetics for consulting; Received grant/research funds from Galderma for principal investigator.

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Lower back part of the legs shows hypopigmentation, induration, biopsy site, and asymmetric involvement.
Posterior thigh shows woody induration, sclerosis, and hypopigmentation.
Close-up view of left posterior thigh 2 weeks later shows erythema, scaling, alopecia, and rippled induration.
Posterior part of the calf in the first week of illness shows erythema, edema, alopecia, scaling, and early induration. The right calf is relatively uninvolved with patchy erythema only.
Photograph of the posterior part of the calf at 3 weeks shows complete sclerosis and induration with patchy erythema.
Note the marked thickening and replacement of the entire dermis with sclerotic collagen on this incisional biopsy sample from the left posterior part of the thigh.
Photomicrograph of subcutaneous fat-fascia junction shows entrapment of subcutaneous fat by intersecting thick bands of fibrosis. Thickening and fibrosis of fascia and lymphoid aggregates are seen.
Photomicrograph of fascia-skeletal muscle junction shows markedly thickened fascia with heavy inflammatory infiltration.
High-power photomicrograph of fascia shows heavy inflammatory infiltration with numerous eosinophils, lymphocytes, and occasional plasma cells.
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