eMedicine Specialties > Rheumatology > Systemic Rheumatic Disease

Eosinophilic Fasciitis: Follow-up

Author: Peter M Henning, DO, MAJ, MC, Fellow, Department of Rheumatology, Walter Reed Army Medical Center, Washington, DC
Coauthor(s): George R Mount, MD, MAJ USA MC, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Attending Physician, Department of Rheumatology, Walter Reed Army Medical Center, Washington, DC; Nicholas David Kortan, DO, CPT, MC,, Resident Physician, Department of Internal Medicine, Walter Reed Army Medical Center, Washington, DC; Sherif Nasef, MD, Consulting Staff, Department of Internal Medicine, Division of Rheumatology, Lake Havasu Regional Medical Center; Kristine M Lohr, MD, MS, Program Director, Professor, Department of Internal Medicine, Division of Rheumatology and Women's Health, University of Kentucky School of Medicine
Contributor Information and Disclosures

Updated: Oct 2, 2009

Follow-up

Further Outpatient Care

  • Patients with eosinophilic fasciitis (EF) should continue to be treated with corticosteroid therapy in the outpatient setting.

Prognosis

  • A recent retrospective review found that clinical factors associated with persistent fibrosis included presence of morphealike skin lesions, younger age at onset, truncal involvement, and presence of dermal fibrosclerosis on histopathologic specimen.2
  • Loss of edema is usually the first clinical sign of improvement and can occur within 4 weeks of commencing treatment. Concurrently, the skin becomes softer, but 3-6 months may elapse before maximal reduction in induration and contractures is achieved.15,17
  • While total resolution of the clinical signs can occur, some degree of induration remaining even after many months of corticosteroid therapy is not unusual.
  • A direct correlation does not always exist between clinical disease activity and laboratory findings. The eosinophilia and ESR usually return to reference ranges within 6-8 weeks, although the ESR and hypergammaglobulinemia may remain abnormal for up to 12 months.15,17
  • Eventually, corticosteroid therapy can be withdrawn in many of the patients, without relapse occurring.
  • The development of aplastic anemia is a rare but grave complication.38

Miscellaneous

Medicolegal Pitfalls

  • Failure to differentiate eosinophilic fasciitis from scleroderma (ie, misdiagnosis)
 
Acknowledgments

The opinions or assertions contained here are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.



More on Eosinophilic Fasciitis

Overview: Eosinophilic Fasciitis
Differential Diagnoses & Workup: Eosinophilic Fasciitis
Treatment & Medication: Eosinophilic Fasciitis
Follow-up: Eosinophilic Fasciitis
Multimedia: Eosinophilic Fasciitis
References
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Further Reading

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Keywords

eosinophilic fasciitis, EF, eosinophilia, scleroderma, systemic sclerosis, elevated sedimentation rate, elevated ESR, hypergammaglobulinemia, fascial thickening, hematologic disease, Shulman syndrome, Shulman's syndrome, peripheral eosinophilia, fasciitis, fibrosing disorders, diffuse fasciitis with eosinophilia

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Contributor Information and Disclosures

Author

Peter M Henning, DO, MAJ, MC, Fellow, Department of Rheumatology, Walter Reed Army Medical Center, Washington, DC
Peter M Henning, DO, MAJ, MC is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

George R Mount, MD, MAJ USA MC, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Attending Physician, Department of Rheumatology, Walter Reed Army Medical Center, Washington, DC
George R Mount, MD, MAJ USA MC is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Nicholas David Kortan, DO, CPT, MC,, Resident Physician, Department of Internal Medicine, Walter Reed Army Medical Center, Washington, DC
Nicholas David Kortan, DO, CPT, MC, is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Sherif Nasef, MD, Consulting Staff, Department of Internal Medicine, Division of Rheumatology, Lake Havasu Regional Medical Center
Sherif Nasef, MD is a member of the following medical societies: American College of Physicians, American College of Physicians-American Society of Internal Medicine, American College of Rheumatology, and American Medical Association
Disclosure: Nothing to disclose.

Kristine M Lohr, MD, MS, Program Director, Professor, Department of Internal Medicine, Division of Rheumatology and Women's Health, University of Kentucky School of Medicine
Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians, American College of Rheumatology, and American Medical Women's Association
Disclosure: Nothing to disclose.

Medical Editor

John Varga, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Northwestern University
John Varga, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology, Central Society for Clinical Research, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Lawrence H Brent, MD, Associate Professor of Medicine, Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center
Lawrence H Brent, MD is a member of the following medical societies: American Association of Immunologists, American College of Physicians, and American College of Rheumatology
Disclosure: Genentech Honoraria Speaking and teaching; Genentech Grant/research funds Other; Amgen Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Immunology Honoraria Speaking and teaching

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; West Penn Allegheny Health System None Board membership

 
 
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