Diagnostic Considerations

Febrile eosinophilic cellulitis with toxocariasis^[21]and infectious cellulitis (eg, bacterial)^{[41, 42]}need to be considered in the differential diagnosis of Wells syndrome (eosinophilic cellulitis), as does bacterial facial cellulitis,^[43]erysipelas,^[44]and arachnid (tick) bites.^[45]Distinction from Churg-Strauss syndrome is also required.^{[30, 46]}Wells syndrome may need to be distinguished from bullous cellulitis and should be considered if a patient does not to respond to antibiotics.^[34]Cutaneous dirofilariasis may also clinically resemble Wells syndrome.^[47] Also consider terbinafine-induced DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome.^[48]

Differential Diagnoses

Allergic Contact Dermatitis
Arachnid (tick) bites
Bacterial facial cellulitis
Cellulitis
Chronic Urticaria
Dermatologic Manifestations of Eosinophilic Granulomatosis With Polyangiitis (Churg-Strauss Syndrome)
Drug Eruptions
Drug-Induced Bullous Disorders
Erysipelas
Granuloma Annulare
Insect Bites
Lyme Disease
Pediatric Hypereosinophilic Syndrome

Workup

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Media Gallery

A superficial and deep perivascular and interstitial inflammatory pattern. Courtesy of DermNet New Zealand (https://www.dermnetnz.org/assets/Uploads/pathology/t/wellsfigure2.jpg).
Superficial and deep perivascular and interstitial inflammatory pattern extending into the subcutaneous tissue. Courtesy of DermNet New Zealand (https://www.dermnetnz.org/assets/Uploads/pathology/t/wellsfigure3.jpg).

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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.

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, Sigma Xi, The Scientific Research Honor Society

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.

Acknowledgements

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.

Wells Syndrome Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

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