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Medication

Medication Summary

The medications used for the treatment of eosinophilic cellulitis include antifungals, such as griseofulvin; antibiotics, such as dapsone; immunosuppressants, such as cyclosporine and cortisone; and H1 receptor antagonists, such as cyproheptadine and diphenhydramine.^[55]First-generation antihistamines should be used with caution, as they have poor receptor selectivity, cross the blood-brain barrier, reduce rapid eye movement (REM) sleep, and interfere with histaminergic transmission.^[56]Since it tends to resolve, systemic treatment should be used cautiously.^[57]

Systemic corticosteroids are the most effective treatment, but they may lead to corticosteroid dependence.

Class Summary

The mechanism of action of antifungals usually involves inhibiting pathways (enzymes, substrates, transport) necessary for sterol/cell membrane synthesis or altering the permeability of the cell membrane (polyenes) of the fungal cell.

Griseofulvin (Fulvicin P/G, Grifulvin V)

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Griseofulvin has fungistatic activity. Fungal cell division is impaired by interfering with microtubules. It binds to keratin precursor cells. Keratin is gradually replaced by noninfected tissue, which is highly resistant to fungal invasions.

Class Summary

Antibiotic therapy must cover all likely pathogens in the context of this clinical setting.

Dapsone

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Dapsone is bactericidal and bacteriostatic against mycobacteria; its mechanism of action is similar to that of sulfonamides, where competitive antagonists of PABA prevent formation of folic acid, inhibiting bacterial growth.

Class Summary

Immunosuppressant agents inhibit key factors in the immune system responsible for immune reactions.

Cyclosporine (Sandimmune, Neoral, Gengraf)

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Cyclosporine has been demonstrated to be helpful in a variety of skin disorders.

Cortisone

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Cortisone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Prednisone

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Prednisone may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear activity.

Hydrocortisone topical (Cortaid Advanced, Dermacort, Westcort, Ala-Cort, HydroSKIN)

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Hydrocortisone is an adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. It decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability.

Dexamethasone (Baycadron)

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Dexamethasone is used for various allergic and inflammatory diseases. It decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Betamethasone (Diprolene, Celestone, Celestone Soluspan, Luxiq)

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Betamethasone is used for inflammatory dermatoses responsive to steroids. It decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. It affects production of lymphokines and has an inhibitory effect on Langerhans cells.

Class Summary

H1 receptor antagonists act by competitive inhibition of histamine at the H1 receptor. This mediates the wheal-and-flare reactions, bronchial constriction, mucous secretion, smooth muscle contraction, edema, hypotension, CNS depression, and cardiac arrhythmias. These first-generation antihistamines should be used with caution, as they have poor receptor selectivity, cross the blood-brain barrier, reduce rapid eye movement (REM) sleep, and interfere with histaminergic transmission. Histamine is a vital neurotransmitter that increases arousal in the circadian sleep-wake cycle and reinforces learning and memory.

Cyproheptadine

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Cyproheptadine is used for the symptomatic relief of allergic symptoms caused by histamine released in response to allergens and skin manifestations.

Diphenhydramine (AllerMax, Aller-Cap, Anti-Hist, Benadryl)

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Diphenhydramine is used for the symptomatic relief of symptoms caused by release of histamine in allergic reactions.

Chlorpheniramine (Chlor-Trimeton, Teldrin, Aller-Chlor, Chlor-Hist)

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Chlorpheniramine is used to treat intense, localized allergic reactions. This agent competes with histamine or H1-receptor sites on effector cells in blood vessels and the respiratory tract.

Hydroxyzine hydrochloride (Vistaril)

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Hydroxyzine hydrochloride antagonizes H1 receptors in the periphery. It may suppress histamine activity in the subcortical region of the central nervous system (CNS).

Questions

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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 Medication

Medication Summary

Antifungals, Other

Class Summary

Griseofulvin (Fulvicin P/G, Grifulvin V)

Griseofulvin (Fulvicin P/G, Grifulvin V)

Antibiotics, Other

Class Summary

Dapsone

Dapsone

Immunosuppressants

Class Summary

Cyclosporine (Sandimmune, Neoral, Gengraf)

Cyclosporine (Sandimmune, Neoral, Gengraf)

Cortisone

Cortisone

Prednisone

Prednisone

Hydrocortisone topical (Cortaid Advanced, Dermacort, Westcort, Ala-Cort, HydroSKIN)

Hydrocortisone topical (Cortaid Advanced, Dermacort, Westcort, Ala-Cort, HydroSKIN)

Dexamethasone (Baycadron)

Dexamethasone (Baycadron)

Betamethasone (Diprolene, Celestone, Celestone Soluspan, Luxiq)

Betamethasone (Diprolene, Celestone, Celestone Soluspan, Luxiq)

Antihistamines, 1st Generation

Class Summary

Cyproheptadine

Cyproheptadine

Diphenhydramine (AllerMax, Aller-Cap, Anti-Hist, Benadryl)

Diphenhydramine (AllerMax, Aller-Cap, Anti-Hist, Benadryl)

Chlorpheniramine (Chlor-Trimeton, Teldrin, Aller-Chlor, Chlor-Hist)

Chlorpheniramine (Chlor-Trimeton, Teldrin, Aller-Chlor, Chlor-Hist)

Hydroxyzine hydrochloride (Vistaril)

Hydroxyzine hydrochloride (Vistaril)

Wells Syndrome Medication

Medication Summary

Antifungals, Other

Class Summary

Griseofulvin (Fulvicin P/G, Grifulvin V)

Antibiotics, Other

Class Summary

Dapsone

Immunosuppressants

Class Summary

Cyclosporine (Sandimmune, Neoral, Gengraf)

Cortisone

Prednisone

Hydrocortisone topical (Cortaid Advanced, Dermacort, Westcort, Ala-Cort, HydroSKIN)

Dexamethasone (Baycadron)

Betamethasone (Diprolene, Celestone, Celestone Soluspan, Luxiq)

Antihistamines, 1st Generation

Class Summary

Cyproheptadine

Diphenhydramine (AllerMax, Aller-Cap, Anti-Hist, Benadryl)

Chlorpheniramine (Chlor-Trimeton, Teldrin, Aller-Chlor, Chlor-Hist)

Hydroxyzine hydrochloride (Vistaril)

References

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