Diagnostic Considerations

Also consider toxic oil syndrome,^{[33, 34, 35]} polymyositis, and polyarteritis nodosa.

Eosinophilic fasciitis should be differentiated from eosinophilia-myalgia syndrome (EMS).^{[36, 37, 38, 39]}Eosinophilic fasciitis is typically evident as painful swelling with progressive cutaneous and subcutaneous induration of the limbs.^[40]The criterion standard for diagnosis of eosinophilic fasciitis is a deep skin-to-muscle biopsy. Some believe eosinophilic fasciitis to be linked to L-tryptophan ingestion, statins, and, possibly, iron infusions.^[41]

Probiotics, live microorganisms that when administered confer a health benefit, are often used for rheumatic diseases to enhance the immune system despite adverse events including bacteremia and fungemia in immunocompromised patients. Two patients developed a severe eosinophilic syndrome with vasculitis and mononeuritis multiplex, temporally associated with use of a new brand of probiotics.^[42]However, neither had the eosinophilia myalgia syndrome since there was no cutaneous edema, no fibrosis, and no history of L-tryptophan ingestion.

Other hypereosinophilic syndromes should be considered, especially immunoglobulin G4–related disease, but also including eosinophilic fasciitis, drug-induced vasculitis, and toxic oil syndrome.^[43]

Differential Diagnoses

Workup

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Media Gallery

Indurated edematous plaques on a patient with hypereosinophilic syndrome.

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former 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: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

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: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

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.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, David Arbesfeld, MD, Vinay Arya, MD, and Nicole Quartarolo, MD, to the development and writing of this article.

Sections Dermatologic Manifestations of Eosinophilia-Myalgia Syndrome
Overview
Presentation
DDx
Workup
Treatment
Medication
Questions & Answers
References

Dermatologic Manifestations of Eosinophilia-Myalgia Syndrome Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

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