Wells Syndrome Clinical Presentation

Updated: Mar 23, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Usually, the patient with Wells syndrome (eosinophilic cellulitis) 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 cellulitis-like eruption occurs. The clinical presentation may also include annular plaques, vesicles and bullae (bullous Wells syndrome associated with non-Hodgkin lymphoma [37] ), and urticaria. [38]

Systemic symptoms, including asthma, arthralgia, and fever, may be evident, although they usually do not occur. Although long-term sequelae usually do not result, reticular pigmentation and scarring alopecia may occur. Rarely, Wells syndrome is associated with life-threatening diseases such leukemia and lymphoma. [24, 39, 40] However, at this point, determining if these are coincidental findings or real associations is impossible.


Physical Examination

The lesions in patients with Wells syndrome (eosinophilic cellulitis) progress over a few days to become large, indurated plaques of edema and erythema, with violaceous edges and no collar. 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 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.