Wells Syndrome Medication

Updated: Apr 17, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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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. [50] 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. [51] Since it tends to resolve, systemic treatment should be used cautiously. [52]

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

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Antifungals, Other

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)

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.

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Antibiotics, Other

Class Summary

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

Dapsone

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.

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Immunosuppressants

Class Summary

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

Cyclosporine (Sandimmune, Neoral, Gengraf)

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

Cortisone

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

Prednisone

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

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

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)

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)

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.

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Antihistamines, 1st Generation

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

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)

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)

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)

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

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