Medscape is available in 5 Language Editions – Choose your Edition here.


Wells Syndrome Differential Diagnoses

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
Updated: Jun 02, 2016

Diagnostic Considerations

Febrile eosinophilic cellulitis with toxocariasis[20] and infectious cellulitis[39] need to be considered in the differential diagnosis of Wells syndrome (eosinophilic cellulitis). Distinction from Churg-Strauss syndrome is also required.[28] Wells syndrome may need to be distinguished from bullous cellulitis and should be considered if a patient does not to respond to antibiotics.[32] Cutaneous dirofilariasis may also clinically resemble Wells syndrome.[40]

Differential Diagnoses

Contributor Information and Disclosures

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

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

Disclosure: Nothing to disclose.


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, Sigma Xi

Disclosure: Received honoraria from Medicis for review panel membership; Received honoraria from Triax for review panel membership.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

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

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.

  1. Wells GC. Recurrent granulomatous dermatitis with eosinophilia. Trans St Johns Hosp Dermatol Soc. 1971. 57(1):46-56. [Medline].

  2. Wells GC, Smith NP. Eosinophilic cellulitis. Br J Dermatol. 1979 Jan. 100(1):101-9. [Medline].

  3. Brehmer-Andersson E, Kaaman T, Skog E, Frithz A. The histopathogenesis of the flame figure in Wells' syndrome based on five cases. Acta Derm Venereol. 1986. 66(3):213-9. [Medline].

  4. Ghislain PD, Van Eeckhout P. Eosinophilic cellulitis of papulonodular presentation (Wells' syndrome). J Eur Acad Dermatol Venereol. 2005 Mar. 19(2):226-7. [Medline].

  5. Holme SA, McHenry P. Nodular presentation of eosinophilic cellulitis (Wells' syndrome). Clin Exp Dermatol. 2001 Nov. 26(8):677-9. [Medline].

  6. Consigny S, Courville P, Young P, et al. [Histological and clinical forms of the eosinophilic cellulitis]. Ann Dermatol Venereol. 2001 Mar. 128(3 Pt 1):213-6. [Medline].

  7. Davis MD, Brown AC, Blackston RD, et al. Familial eosinophilic cellulitis, dysmorphic habitus, and mental retardation. J Am Acad Dermatol. 1998 Jun. 38(6 Pt 1):919-28. [Medline].

  8. Koga C, Sugita K, Kabashima K, Matsuoka H, Nakamura M, Tokura Y. High responses of peripheral lymphocytes to mosquito salivary gland extracts in patients with Wells syndrome. J Am Acad Dermatol. 2010 Jul. 63(1):160-1. [Medline].

  9. Tatsuno K, Fujiyama T, Matsuoka H, Shimauchi T, Ito T, Tokura Y. Clinical categories of exaggerated skin reactions to mosquito bites and their pathophysiology. J Dermatol Sci. 2016 Jun. 82 (3):145-52. [Medline].

  10. Plotz SG, Abeck D, Behrendt H, Simon HU, Ring J. [Eosinophilic cellulitis (Wells syndrome)]. Hautarzt. 2000 Mar. 51(3):182-6. [Medline].

  11. Espana A, Sanz ML, Sola J, Gil P. Wells' syndrome (eosinophilic cellulitis): correlation between clinical activity, eosinophil levels, eosinophil cation protein and interleukin-5. Br J Dermatol. 1999 Jan. 140(1):127-30. [Medline].

  12. Kaufmann D, Pichler W, Beer JH. Severe episode of high fever with rash, lymphadenopathy, neutropenia, and eosinophilia after minocycline therapy for acne. Arch Intern Med. 1994 Sep 12. 154(17):1983-4. [Medline].

  13. Hirsch K, Ludwig RJ, Wolter M, et al. Eosinophilic cellulitis (Wells' syndrome) associated with colon carcinoma. J Dtsch Dermatol Ges. 2005 Jul. 3(7):530-1. [Medline].

  14. Heelan K, Ryan JF, Shear NH, Egan CA. Wells syndrome (eosinophilic cellulitis): Proposed diagnostic criteria and a literature review of the drug-induced variant. J Dermatol Case Rep. 2013. 7(4):113-20. [Medline]. [Full Text].

  15. Simpson JK, Patalay R, Francis N, Roberts N. Influenza Vaccination as a Novel Trigger of Wells Syndrome in a Child. Pediatr Dermatol. 2015 Apr 20. [Medline].

  16. Brun J, Chiaverini C, Bessis D, Bourrat E, Lasek-Duriez A, Hadj-Rabia S, et al. [Wells Syndrome in children and atopy: Retrospective study of 11 cases and review of the literature]. Ann Dermatol Venereol. 2015 Apr 3. [Medline].

  17. Lin HL, Lin JN, Chen CW, Kuo LC, Lee WC. Eosinophilic cellulitis after honeybee sting. J Formos Med Assoc. 2009 Dec. 108(12):964-6. [Medline].

  18. Cherng E, McClung AA, Rosenthal HM, Hicks J, Levy ML. Wells' Syndrome Associated with Parvovirus in a 5-Year Old Boy. Pediatr Dermatol. 2011 Dec 9. [Medline].

  19. Hurni MA, Gerbig AW, Braathen LR, Hunziker T. Toxocariasis and Wells' syndrome: a causal relationship?. Dermatology. 1997. 195(4):325-8. [Medline].

  20. Bassukas ID, Gaitanis G, Zioga A, Boboyianni C, Stergiopoulou C. Febrile "migrating" eosinophilic cellulitis with hepatosplenomegaly: adult toxocariasis - a case report. Cases J. 2008 Nov 28. 1(1):356. [Medline].

  21. Tsuda S, Tanaka K, Miyasato M, Nakama T, Sasai Y. Eosinophilic cellulitis (Wells' syndrome) associated with ascariasis. Acta Derm Venereol. 1994 Jul. 74(4):292-4. [Medline].

  22. van den Hoogenband HM. Eosinophilic cellulitis as a result of onchocerciasis. Clin Exp Dermatol. 1983 Jul. 8(4):405-8. [Medline].

  23. Aslam A, Salman W, Chaudhry IH, Coulson IH, Owen CM. Bullous eosinophilic cellulitis associated with giardiasis. Clin Exp Dermatol. 2013 Jul 23. [Medline].

  24. Zhu L, Hu D, Wang Q, Hou J, Li M. Diffuse polymorphic eosinophilic cellulitis in a patient with metallic alloy implants: a possible association?. Int J Dermatol. 2011 Dec. 50(12):1535-7. [Medline].

  25. Lee SH, Roh MR, Jee H, Chung KY, Jung JY. Wells' syndrome associated with churg-strauss syndrome. Ann Dermatol. 2011 Nov. 23(4):497-500. [Medline]. [Full Text].

  26. Fujimoto N, Wakabayashi M, Kato T, Nishio C, Tanaka T. Wells syndrome associated with Churg–Strauss syndrome. Clin Exp Dermatol. 2011 Jan. 36(1):46-8. [Medline].

  27. Yin G, Xie Q. Systemic lupus erythematosus associated with Wells' syndrome. Rheumatol Int. 2011 Feb 22. [Medline].

  28. Omiya W, Fujita Y, Baba K, Shibaki A, Odani T, Shimizu H. Unusual cutaneous manifestations of Churg-Strauss syndrome mimicking Wells' syndrome. Eur J Dermatol. 2012 Jun 15. [Medline].

  29. Ratzinger G, Zankl J, Zelger B. Wells syndrome and its relationship to Churg-Strauss syndrome. Int J Dermatol. 2013 Aug. 52(8):949-54. [Medline].

  30. Anderson CR, Jenkins D, Tron V, Prendiville JS. Wells' syndrome in childhood: case report and review of the literature. J Am Acad Dermatol. 1995 Nov. 33(5 Pt 2):857-64. [Medline].

  31. Nielsen T, Schmidt H, Sogaard H. Eosinophilic cellulitis. (Well's syndrome) in a child. Arch Dermatol. 1981 Jul. 117(7):427-9. [Medline].

  32. Shams M, Hudgens J, Lesher JL Jr, Florentino F. Wells' syndrome presenting as a noninfectious bullous cellulitis in a child. Pediatr Dermatol. 2012 Mar. 29(2):224-6. [Medline].

  33. Powell JG, Ramsdell A, Rothman IL. Eosinophilic cellulitis (Wells syndrome) in a pediatric patient: a case report and review of the literature. Cutis. 2012 Apr. 89(4):191-4. [Medline].

  34. Caputo R, Marzano AV, Vezzoli P, Lunardon L. Wells syndrome in adults and children: a report of 19 cases. Arch Dermatol. 2006 Sep. 142(9):1157-61. [Medline].

  35. Spinelli M, Frigerio E, Cozzi A, Garutti C, Garavaglia MC, Altomare G. Bullous Wells' syndrome associated with non-Hodgkin's lymphocytic lymphoma. Acta Derm Venereol. 2008. 88(5):530-1. [Medline].

  36. Odia SG, Purschel W, Worret WI, Rakoski J. Hypereosinophilic cellulitis(Wells' syndrome) resembling urticaria. Acta Derm Venerol (Ljubljana). 1994. 6:193-195.

  37. Mutasim DF, Cooper CH. A case of Wells' syndrome in a patient with lymphocytic lymphoma. Geriatr Dermatol. 1996. 4(1):11-14.

  38. Pessach I, Petevi K, Gkirkas K, Stamouli M, Constantinou P, Rontogianni D, et al. Wells' syndrome with a clinicopathological correlation associated with mantle-cell lymphoma. Leuk Lymphoma. 2016 Mar 21. 1-3. [Medline].

  39. Falagas ME, Vergidis PI. Narrative review: diseases that masquerade as infectious cellulitis. Ann Intern Med. 2005 Jan 4. 142(1):47-55. [Medline].

  40. Benzaquen M, Brajon D, Delord M, Yin N, Bittar F, Toga I, et al. Cutaneous and pulmonary dirofilariasis due to Dirofilaria repens. Br J Dermatol. 2015 Apr 27. [Medline].

  41. Leiferman KM, Peters MS. Reflections on eosinophils and flame figures: where there's smoke there's not necessarily Wells syndrome. Arch Dermatol. 2006 Sep. 142(9):1215-8. [Medline].

  42. Moossavi M, Mehregan DR. Wells' syndrome: a clinical and histopathologic review of seven cases. Int J Dermatol. 2003 Jan. 42(1):62-7. [Medline].

  43. Stern JB, Sobel HJ, Rotchford JP. Wells' syndrome: is there collagen damage in the flame figures?. J Cutan Pathol. 1984 Dec. 11(6):501-5. [Medline].

  44. Peters MS, Schroeter AL, Gleich GJ. Immunofluorescence identification of eosinophil granule major basic protein in the flame figures of Wells' syndrome. Br J Dermatol. 1983 Aug. 109(2):141-8. [Medline].

  45. Aberer W, Konrad K, Wolff K. Wells' syndrome is a distinctive disease entity and not a histologic diagnosis. J Am Acad Dermatol. 1988 Jan. 18(1 Pt 1):105-14. [Medline].

  46. Haddad F, Helm TN. Wells syndrome. Cutis. 2014 Jan. 93(1):17, 38-9. [Medline].

  47. Herr H, Koh JK. Eosinophilic cellulitis (Wells' syndrome) successfully treated with low-dose cyclosporine. J Korean Med Sci. 2001 Oct. 16(5):664-8. [Medline].

  48. Church MK, Maurer M, Simons FE, et al. Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper. Allergy. 2010 Apr. 65(4):459-66. [Medline].

  49. Brown J, Schwartz RA. Wells' syndrome (eosinophilic cellulitis). Cesko-Slovenska Dermatol. 2002. 77:261-263.

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.