Wells Syndrome (Eosinophilic Cellulitis) Clinical Presentation

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 16, 2012
 

History

Usually, the patient reports pruritus or a burning sensation, which is followed by erythema and edema. Occasionally, papular and nodular eruptions may be seen first. Typically, a tender or mildly pruritic cellulitislike eruption occurs. Systemic symptoms, including asthma, arthralgia, and fever, may be evident, although they usually do not occur.

The clinical presentation can vary widely and may include the following:

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Physical

The lesions progress over a few days to become large, indurated plaques of edema and erythema, with violaceous edges and no calor. The lesions may last for several weeks, but they gradually darken from bright red to slate blue. Complete resolution with no scarring is typical, although scarring alopecia may occur.

The plaques can occur anywhere on the skin, and they may be solitary or multiple. Plaques on the affected areas are known to recur, and vesiculobullae may develop over the surface.

The clinical features seem to depend on the location of the infiltrates in the dermis. This observation suggests that a spectrum of eosinophilic dermatoses occurs in Wells syndrome.

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Causes

The etiology is unknown. Wells syndrome is usually sporadic, but some familial cases have been described. Suggested precipitating factors include the following:

  • Arthropod bites and stings, including those of the honeybee[18]
  • Cutaneous viral infections: There is a possible link between parvoviral infection and Wells syndrome.[19]
  • Cutaneous parasitic infestations, including toxocariasis,[20, 21] ascariasis,[22] and onchocerciasis[23]
  • Leukemia
  • Myeloproliferative disorders
  • Atopic dermatitis
  • Fungal infections
  • Hypersensitivity reactions to medications or metals, including metallic alloy implants[24]
  • Churg-Strauss syndrome: This syndrome has been associated in a few patients.[25] These reports are noteworthy for the presence of bullae and of antineutrophil cytoplasmic antibodies.[26] Only a few other autoimmune diseases have been associated, including a case report of systemic lupus erythematosus.[27]
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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Justin Brown, MD  Dermatologist, The Dermatology Group

Justin Brown, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for MOHS Surgery, and Sigma Xi

Disclosure: Medicis Honoraria Review panel membership; Triax Honoraria Review panel membership

Specialty Editor Board

Takeji Nishikawa, MD  Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

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

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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