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Michelerio A, Rubatto M, Roccuzzo G, Coscia M, Quaglino P, Tomasini C. Eosinophilic Dermatosis of Hematologic Malignancy: Emerging Evidence for the Role of Insect Bites-A Retrospective Clinico-Pathological Study of 35 Cases. J Clin Med 2024; 13:2935. [PMID: 38792476 PMCID: PMC11121821 DOI: 10.3390/jcm13102935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Eosinophilic dermatosis of hematologic malignancy (EDHM) is a rare cutaneous disorder associated with various hematologic malignancies, most commonly chronic lymphocytic leukemia. Detailed clinicopathologic studies of EDHM are lacking and the pathogenesis remains enigmatic. Initially thought to be a hypersensitivity reaction to insect stings, subsequent reports have challenged this understanding. The prognostic implications of EDHM remain unclear. Methods: A retrospective clinicopathologic study was performed on patients diagnosed with EDHM. Hematologic and dermatologic data were reviewed. Histologic specimens were re-evaluated and lesions were classified into acute/subacute, fully developed, and chronic/regressing. Results: The study included 35 patients. In 80% of these patients, EDHM was diagnosed after the hematologic disorder. Approximately 45% of the cohort experienced hematologic disease progression or relapse, while 65% required therapeutic intervention during the course of their hematologic disease. In total, 15/19 CLL patients had non-mutated IgHV, a marker of a more aggressive hematologic disease course. Dermatologic lesion morphology was heterogeneous, with most lesions occurring on exposed areas, and a significant 94% of patients demonstrated lesion seasonality. Histopathologic findings were consistent with features typically associated with insect bites. In addition, examination of lesions at different chronological stages revealed substantial similarities with Wells syndrome. Conclusions: Our findings support the potential role of insect bites in triggering EDHM in the context of adaptive immune dysfunction. EDHM may be associated with a more aggressive disease course or may be a marker of disease progression. The observed co-occurrence of features typical of Wells syndrome in EDHM patients suggests that these conditions are part of a spectrum of disorders that vary in clinical expression.
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Affiliation(s)
- Andrea Michelerio
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Marco Rubatto
- Department of Medical Sciences, Section of Dermatology, University of Turin, 10126 Turin, Italy
| | - Gabriele Roccuzzo
- Department of Medical Sciences, Section of Dermatology, University of Turin, 10126 Turin, Italy
| | - Marta Coscia
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, 10126 Turin, Italy
| | - Carlo Tomasini
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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2
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Morot J, Del Duca E, Chastagner M, Fernandes M, Estrada Y, Lefevre MA, Kanitakis J, Harou O, Jullien D, Nicolas JF, Krueger JG, Vocanson M, Guttman-Yassky E, Villani AP. Hyperactivation of the JAK2/STAT5 Signaling Pathway and Evaluation of Baricitinib Treatment Among Patients With Eosinophilic Cellulitis. JAMA Dermatol 2023; 159:820-829. [PMID: 37342057 PMCID: PMC10285679 DOI: 10.1001/jamadermatol.2023.1651] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/26/2023] [Indexed: 06/22/2023]
Abstract
Importance The pathogenesis of eosinophilic cellulitis (EC) is poorly understood, limiting available treatment options. The current treatment paradigm focuses on delayed type 2 hypersensitivity reaction to various triggers. Objective To gain further insight into the nature of EC inflammation and into the cellular signal transduction pathways that are activated in the context of EC. Design, Setting, and Participants This case series was conducted in Lyon, France, from January 2018 to December 2021. Analysis of archival skin biopsy samples from patients with EC and from healthy control participants was performed using histology, Janus kinase (JAK)-signal transducer and activator of transcription (STAT) immunohistochemistry, and gene profiling. Data analysis was conducted between January 2020 and January 2022. Main Outcomes and Measures Pruritus (visual analog score), percentage of body surface area with lesional skin, and RNA transcripts of inflammatory biomarkers from the skin (threshold cycle) were assessed in 1 index patient with refractory EC who received oral JAK1/JAK2 inhibitor baricitinib (4 mg/d). Results This study included samples from 14 patients with EC (7 men and 7 women) and 8 healthy control participants (4 men and 4 women). The mean (SD) age of patients was 52 (20) years. Marked type 2 inflammation (chemokines CCL17, CCL18, and CCL26 and interleukin 13) with preferential activation of the JAK1/JAK2-STAT5 pathways in EC lesions was observed. In the 1 index patient with refractory EC, complete clinical remission of skin lesions was observed after 1 month of treatment with baricitinib. Conclusions and Relevance These findings suggest that EC is a type 2 inflammatory disease with preferential activation of the JAK1/JAK2-STAT5 pathways. In addition, these results suggest the potential of treatment approaches targeting JAK1/JAK2 for patients with EC.
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Affiliation(s)
- Johanna Morot
- Centre International de Recherche en Infectiologie, Université Claude Bernard Lyon 1, Inserm U1111, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Ester Del Duca
- Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Marine Chastagner
- Centre International de Recherche en Infectiologie, Université Claude Bernard Lyon 1, Inserm U1111, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Marie Fernandes
- Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Yeriel Estrada
- Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Marine-Alexia Lefevre
- Centre International de Recherche en Infectiologie, Université Claude Bernard Lyon 1, Inserm U1111, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Jean Kanitakis
- Department of Dermatology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Department of Pathology, Hôpital Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Olivier Harou
- Department of Pathology, Hôpital Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Denis Jullien
- Centre International de Recherche en Infectiologie, Université Claude Bernard Lyon 1, Inserm U1111, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Jean-Francois Nicolas
- Centre International de Recherche en Infectiologie, Université Claude Bernard Lyon 1, Inserm U1111, CNRS, UMR5308, ENS Lyon, Lyon, France
- Department of Allergology and Immunology, Hôpital Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - James G. Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York
| | - Marc Vocanson
- Centre International de Recherche en Infectiologie, Université Claude Bernard Lyon 1, Inserm U1111, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Emma Guttman-Yassky
- Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Axel P. Villani
- Centre International de Recherche en Infectiologie, Université Claude Bernard Lyon 1, Inserm U1111, CNRS, UMR5308, ENS Lyon, Lyon, France
- Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
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3
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Lagacé F, D’Aguanno K, Prosty C, Laverde-Saad A, Cattelan L, Ouchene L, Oliel S, Genest G, Doiron P, Richer V, Jfri A, O’Brien E, Lefrançois P, Powell M, Moreau L, Litvinov IV, Muntyanu A, Netchiporouk E. The Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications. J Cutan Med Surg 2023; 27:NP1-NP36. [PMID: 37401812 PMCID: PMC10486181 DOI: 10.1177/12034754231177582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Sex and gender have increasingly been recognized as significant risk factors for many diseases, including dermatological conditions. Historically, sex and gender have often been grouped together as a single risk factor in the scientific literature. However, both may have a distinct impact on disease incidence, prevalence, clinical presentation, severity, therapeutic response, and associated psychological distress. OBJECTIVES AND PROJECT DESCRIPTION The mechanisms that underlie differences in skin diseases between males, females, men, and women remain largely unknown. The specific objectives of this review paper are:To highlight the biological differences between males and females (sex), as well as the sociocultural differences between men and women (gender) and how they impact the integumentary system.To perform a literature review to identify important sex- and gender-related epidemiological and clinical differences for various skin conditions belonging to a range of disease categories and to discuss possible biological and sociocultural factors that could explain the observed differences.To discuss dermatological skin conditions and gender-affirming treatments within the transgender community, a population of individuals who have a gender identity which is different than the gender identity they were assigned at birth. FUTURE IMPACT With the rising number of individuals that identify as non-binary or transgender within our increasingly diverse communities, it is imperative to recognize gender identity, gender, and sex as distinct entities. By doing so, clinicians will be able to better risk-stratify their patients and select treatments that are most aligned with their values. To our knowledge, very few studies have separated sex and gender as two distinct risk factors within the dermatology literature. Our article also has the potential to help guide future prevention strategies that are patient-tailored rather than using a universal approach.
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Affiliation(s)
- François Lagacé
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | | | - Connor Prosty
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Alexandra Laverde-Saad
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Leila Cattelan
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Lydia Ouchene
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Sarah Oliel
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Genevieve Genest
- Division of Allergy and Immunology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philip Doiron
- Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Abdulhadi Jfri
- Department of Dermatology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Elizabeth O’Brien
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philippe Lefrançois
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Mathieu Powell
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Linda Moreau
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Ivan V. Litvinov
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Anastasiya Muntyanu
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
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4
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Vongsachang H, Bleicher ID, Reshef ER, Stagner AM, Wolkow N. Wells Syndrome Presenting as Atypical Periorbital Cellulitis. Ophthalmic Plast Reconstr Surg 2022; 38:e167-e170. [PMID: 35699219 DOI: 10.1097/iop.0000000000002220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 62-year-old man presented with diffuse, painless, left-sided preseptal edema, erythema, and woody induration extending to the left temple. The induration generated an orbital compartment syndrome with markedly elevated intraocular pressure necessitating lateral canthotomy and cantholysis. Although atypical for an infectious etiology, empiric broad-spectrum intravenous antibiotics were initiated with no improvement. A tissue biopsy demonstrated extensive perivascular and interstitial eosinophils with focal flame figures, and the patient was diagnosed with a severe hypersensitivity reaction or eosinophilic cellulitis (Wells syndrome). The disease process remitted rapidly upon initiation of oral prednisone. Wells syndrome is a rare inflammatory eosinophilic dermatosis, most often presenting in the limbs and trunk, with few reports of facial and periorbital involvement. This case highlights the importance of considering Wells syndrome in the differential diagnosis of atypical periorbital cellulitis that is nonresponsive to antibiotics and reviews the clinicopathologic nature of this disease.
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Affiliation(s)
| | - Isaac D Bleicher
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Edith R Reshef
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Anna M Stagner
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Natalie Wolkow
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
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5
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Robertson JC, Rudzinski ER, Boos MD. Abrupt onset of annular plaques and nodules in a young boy. Pediatr Dermatol 2022; 39:297-299. [PMID: 35188287 DOI: 10.1111/pde.14895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/15/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Jake C Robertson
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Erin R Rudzinski
- Division of Pathology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Markus D Boos
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
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6
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Kim Y, Kim YC. Wells' syndrome following Oxford-AstraZeneca COVID-19 vaccination. J Eur Acad Dermatol Venereol 2022; 36:e328-e330. [PMID: 35015930 DOI: 10.1111/jdv.17916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/07/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Yulhee Kim
- Department of Dermatology, Ajou University, School of Medicine, Suwon, Korea
| | - You Chan Kim
- Department of Dermatology, Ajou University, School of Medicine, Suwon, Korea
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7
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Shakshouk H, Johnson EF, Peters MS, Wieland CN, Comfere NI, Lehman JS. Cutaneous eccrine inflammation and necrosis: review of inflammatory disorders affecting the eccrine apparatus including new associations. Hum Pathol 2021; 118:71-85. [PMID: 34450084 DOI: 10.1016/j.humpath.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/30/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022]
Abstract
Despite being frequently overlooked during the examination of histopathological sections, eccrine sweat glands can offer clues for diagnosing various skin conditions. They provide important functions and can lead to several diseases when inflamed or injured. This review article provides information regarding eccrine physiology as well as well-established and novel entities that occur in association with eccrine gland pathology.
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Affiliation(s)
- Hadir Shakshouk
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Dermatology, Andrology and Venereology, Alexandria University, Alexandria, 21131, Egypt
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Margot S Peters
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nneka I Comfere
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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8
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Janssen C, Lauwers N, Leysen I. Wells Syndrome as a Rare Cause of Unilateral Ptosis. Ocul Oncol Pathol 2021; 7:190-193. [PMID: 34307331 DOI: 10.1159/000511595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022] Open
Abstract
We present a case of a woman with a swollen upper eyelid in ptosis, conjunctival nodules, and chemosis present for a couple of weeks. She did not respond to therapy for hordeolum or allergy. A biopsy followed by histopathological examination showed a large infiltration of eosinophilic granulocytes and flame figures, so the diagnosis of Wells syndrome was made. Oral methylprednisolone in high dose was necessary, and tapering was slow because of frequent bouts of relapse. After 3 months, the swelling and hard feeling of the eyelid disappeared, but a slight ptosis remained. Eyelid swelling and eosinophilia recurred 18 months after resolution of the first episode.
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Affiliation(s)
- Caroline Janssen
- Department of Ophthalmology, University Hospital of Antwerp, Edegem, Belgium
| | - Noémie Lauwers
- Department of Ophthalmology, University Hospital of Antwerp, Edegem, Belgium
| | - Inge Leysen
- Department of Ophthalmology, University Hospital of Antwerp, Edegem, Belgium
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Ang WC, Oh HML, Sim CS, Ang CC. A red swollen forearm in an elderly man. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:450-451. [PMID: 34100526 DOI: 10.47102/annals-acadmedsg.2020384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Wan Chen Ang
- Department of Dermatology, Changi General Hospital, Singapore
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10
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Mejbel HA, Preiszner J, Shurbaji MS, Leicht SS, Youngberg GA. Luna stain: a simple and cost-effective diagnostic tool helps in detecting eosinophilic granules deposition of flame figures and aids in diagnosing eosinophilic cellulitis "Wells Syndrome". J Histotechnol 2020; 43:196-199. [PMID: 33245262 DOI: 10.1080/01478885.2020.1818456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report a rare case of Wells syndrome in which a 61-year-old Caucasian male presented with three distinct skin lesions including a cutaneous bulla, an erythematous plaque, and a linear streak located on the patient's left anterior thigh, left dorsal wrist, and left anterior forearm, respectively. Histologic examination revealed diffuse and interstitial eosinophilic infiltrate admixed with lymphocytes and macrophages that predominantly involve the dermis. Nodular aggregates of eosinophils surrounding dermal collagen fibers suggestive of 'flame figures' were identified. Luna histochemical stain was used and highlighted the deposition of eosinophilic granules over the collagen bundles confirming the presence of flame figures. Laboratory workup revealed peripheral eosinophilia, but a comprehensive clinical evaluation failed to reveal a systemic disease and ultimately the diagnosis of eosinophilic cellulitis 'Wells Syndrome' was rendered. After a short course of immunosuppressive therapy, the patient experienced a complete resolution of the skin lesions on his last follow-up visit several weeks from the initial diagnosis. This case highlights the various clinical forms that Wells syndrome may present with and may serve as a good example for the use of Luna stain as a simple and cost-effective diagnostic tool that can help to arrive at the accurate diagnosis and inform therapy.
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Affiliation(s)
- Haider A Mejbel
- Department of Pathology, East Tennessee State University Quillen College of Medicine , Johnson City, TN, USA.,Current Affiliation: Department of Pathology, The University of Alabama at Birmingham , Birmingham, AL, USA
| | - Johanna Preiszner
- Department of Pathology, East Tennessee State University Quillen College of Medicine , Johnson City, TN, USA
| | - M Salah Shurbaji
- Department of Pathology, East Tennessee State University Quillen College of Medicine , Johnson City, TN, USA
| | - Stuart S Leicht
- Department of Dermatology, East Tennessee State University Quillen College of Medicine , Johnson City, TN, USA
| | - George A Youngberg
- Department of Pathology, East Tennessee State University Quillen College of Medicine , Johnson City, TN, USA
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Alves P, Foale R, Cerundolo R, Valls Sànchez F. Canine acute eosinophilic dermatitis with oedema (Wells‐like syndrome) associated with T‐cell multicentric lymphoma. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Eosinophilic dermatoses encompass a broad spectrum of diseases of different etiologies hallmarked by eosinophilic infiltration of the skin and/or mucous membranes, with or without associated blood eosinophilia. The wide range of dermatological manifestations of this spectrum, including nodules and plaques, pustules, blisters, ulcers, and urticarial lesions, is reflected in a non-univocal classification system. We identified six groups of eosinophilic dermatoses based on the predominant anatomic level of involvement: (1) epidermal; (2) of the dermal-epidermal junction; (3) dermal; (4) of the hypodermis and muscle fascia; (5) of the pilosebaceous unit; and (6) vascular/perivascular. We review clinicopathologic features and management of diseases belonging to each group, particularly: (1) pemphigus herpetiformis and atopic dermatitis as prototypes of the epidermal group; (2) bullous pemphigoid as prototypic eosinophilic dermatosis of the dermal-epidermal junction; (3) eosinophilic cellulitis (Wells syndrome), hypereosinophilic syndromes, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, eosinophilic dermatosis of hematologic malignancy and chronic spontaneous urticaria as paradigmatic dermal eosinophilic dermatoses; (4) eosinophilic fasciitis as an eosinophilic dermatosis with predominant involvement of the hypodermis and muscle fascia; (5) eosinophilic pustular folliculitis as a model of the pilosebaceous unit involvement; and (6) granuloma faciale, angiolymphoid hyperplasia with eosinophilia, and eosinophilic granulomatosis with polyangiitis, belonging to the vascular/perivascular group.
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Ogueta I, Spertino J, Deza G, Alcantara Luna S, Zaragoza Ninet V, Pujol R, Giménez‐Arnau A. Wells syndrome and chronic spontaneous urticaria: report of four cases successfully treated with omalizumab. J Eur Acad Dermatol Venereol 2019; 33:e388-e391. [DOI: 10.1111/jdv.15683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- I. Ogueta
- Department of Dermatology Hospital del Mar, IMIM, Universitat Autònoma Barcelona Spain
- Department of Dermatology, Faculty of Medicine Pontificia Universidad Católica de Chile Chile
| | - J. Spertino
- Department of Dermatology Hospital de la Santa Creu i Sant Pau Barcelona Spain
| | - G. Deza
- Department of Dermatology Hospital del Mar, IMIM, Universitat Autònoma Barcelona Spain
| | | | - V. Zaragoza Ninet
- Department of Dermatology Hospital General de Valencia Valencia Spain
| | - R.M. Pujol
- Department of Dermatology Hospital del Mar, IMIM, Universitat Autònoma Barcelona Spain
| | - A.M. Giménez‐Arnau
- Department of Dermatology Hospital del Mar, IMIM, Universitat Autònoma Barcelona Spain
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14
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The Dynamics of the Skin's Immune System. Int J Mol Sci 2019; 20:ijms20081811. [PMID: 31013709 PMCID: PMC6515324 DOI: 10.3390/ijms20081811] [Citation(s) in RCA: 293] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 12/12/2022] Open
Abstract
The skin is a complex organ that has devised numerous strategies, such as physical, chemical, and microbiological barriers, to protect the host from external insults. In addition, the skin contains an intricate network of immune cells resident to the tissue, crucial for host defense as well as tissue homeostasis. In the event of an insult, the skin-resident immune cells are crucial not only for prevention of infection but also for tissue reconstruction. Deregulation of immune responses often leads to impaired healing and poor tissue restoration and function. In this review, we will discuss the defensive components of the skin and focus on the function of skin-resident immune cells in homeostasis and their role in wound healing.
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15
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Abstract
Das Wells-Syndrom, auch als eosinophile Zellulitis bezeichnet, ist eine seltene, sporadisch auftretende eosinophile Dermatose mit polymorphem klinischem Bild. Als typisch gelten entzündliche Erytheme oder Plaques an den Extremitäten, die initial als Erysipel imponieren können, unter antimikrobieller Behandlung aber persistieren. Die eosinophile Zellulitis ist eine Ausschlussdiagnose, die in Zusammenschau von klinischem Befund und charakteristischem histologischem Bild (Flammenfiguren) nur im Verlauf gestellt werden kann. Mit einer Vielzahl möglicher Triggerfaktoren ist die Ätiologie nicht geklärt. Die Beteiligung abnormer Th2-Zellen, des Zytokins IL-5 und aktivierter eosinophiler Granulozyten lässt eine unspezifische Hypersensitivitätsreaktion auf exo- und endogene Stimuli vermuten. Die häufiger vorkommenden chronisch- rezidivierenden Formen lassen sich durch Glukokortikoide günstig beeinflussen. Der Verlauf ist meist selbstlimitierend, ohne Residuen. Aufgrund von Übergängen in hämatoonkologische Erkrankungen sind Verlaufskontrollen angezeigt.
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Affiliation(s)
- Andreas Benedikt Weins
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm.,Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München
| | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München
| | - Tina Weiss
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm
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Abstract
A rare eosinophilic dermatosis, Wells syndrome, also referred to as eosinophilic cellulitis, is characterized by great clinical variability. Typical findings include infiltrated erythematous plaques arising on the extremities. Lesions initially resemble erysipelas/cellulitis, however, they do not improve with antibiotic treatment. Eosinophilic cellulitis is a diagnosis of exclusion that may only be made over the course of the disease, taking into account clinical and characteristic histological findings (flame figures). Although multiple potential triggers have been proposed, the exact etiology remains unresolved. Involvement of abnormal Th2 cells, IL-5, and activated eosinophilic granulocytes suggest a nonspecific hypersensitivity response to exogenous or endogenous stimuli. Corticosteroids may have a beneficial effect on the chronic, recurrent course frequently observed. The disease is often self-limiting, healing without sequelae. Given that transitions to hematological and oncological disorders have been observed, patients should be closely followed up.
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Affiliation(s)
- Andreas Benedikt Weins
- Department of Dermatology and Allergology, University Hospital Ulm, Ulm, Germany.,Department of Dermatology and Allergology, Biederstein Campus, Technical University Munich (TUM), Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergology, Biederstein Campus, Technical University Munich (TUM), Munich, Germany
| | - Tina Weiss
- Department of Dermatology and Allergology, University Hospital Ulm, Ulm, Germany
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Puzas ÁI, Álvarez LM, Menéndez ÁF, Romero Yuste S, Gómez OP. Wells' Syndrome Successfully Treated with Colchicine. Case Rep Dermatol 2017; 9:65-69. [PMID: 28868003 PMCID: PMC5567002 DOI: 10.1159/000477756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/23/2017] [Indexed: 01/16/2023] Open
Abstract
Eosinophilic cellulitis is an uncommon, inflammatory and chronic disorder of unknown etiology. Corticosteroids are currently considered as the first-line treatment but they are not without significant disadvantages such as contraindications in steroid-resistant cases and patients with frequent recurrences. We report a patient suffering from Wells' syndrome with a 24-year history of symptomatic and generalized skin lesions. After consultation in our department, treatment with colchicine 1 mg/day was prescribed resulting in large clinical improvement. No side effects have been recorded. To our knowledge, this is an original disease approach. Although small, our clinical experience supports the inclusion of colchicine in the drug armamentarium when treating patients suffering from Wells' syndrome. Indeed, its excellent safety profile makes it very attractive for patients with frequent recurrent episodes who need secure options for the medium- and long-term disease control.
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Affiliation(s)
- Álvaro Iglesias Puzas
- Dermatology Department, Complejo Hospitalario Universitario de Pontevedra, EOXI Pontevedra-Salnés, Pontevedra, Spain
| | - Laura Mesa Álvarez
- Dermatology Department, Complejo Hospitalario Universitario de Pontevedra, EOXI Pontevedra-Salnés, Pontevedra, Spain
| | - Ángeles Flórez Menéndez
- Dermatology Department, Complejo Hospitalario Universitario de Pontevedra, EOXI Pontevedra-Salnés, Pontevedra, Spain
| | - Susana Romero Yuste
- Rheumathology Department, Complejo Hospitalario Universitario de Pontevedra, EOXI Pontevedra-Salnés, Pontevedra, Spain
| | - Olga Prieto Gómez
- Pathology Department, Complejo Hospitalario Universitario de Pontevedra, EOXI Pontevedra-Salnés, Pontevedra, Spain
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Gallard C, Law-Ping-Man S, Darrieux L, Tisseau L, Safa G. Syndrome de Wells mimant une cellulite infectieuse de la face : trois observations. Ann Dermatol Venereol 2017; 144:284-289. [DOI: 10.1016/j.annder.2016.09.676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/22/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022]
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Lekić B, Gajić-Veljić M, Nikolić M. Granuloma Annulare-like Wells Syndrome in a Child - A Case Report. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2017. [DOI: 10.1515/sjdv-2016-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Wells syndrome (WS) is a rare inflammatory skin disease of unknown etiology. Possible triggers for WS include insect bites/stings, infections, medications, malignancies, and vaccination. Most cases have been reported in adults, but WS may also occur in children.
We report a case of idiopathic WS in a 12-year-old boy, who presented with pruritic papulonodular and granuloma annulare-like lesions on his legs. The patient had an excellent response to topical and systemic corticosteroids.
WS may present as plaque, granuloma annulare-like, urticaria-like, papulovesicular, bullous, papulonodular, or fixed drug eruption-like lesions. Erythematous annular lesions are most common in adults, while plaques are mostly found in children. The histopathologic features are dynamic, starting with dermal edema and infiltration of eosinophils, then flame figures develop, and finishing with the appearance of histiocytes and giant cells.
Our patient represents a rare pediatric case with granuloma annulare-like WS syndrome.
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Affiliation(s)
- Branislav Lekić
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Republic of Serbia
| | - Mirjana Gajić-Veljić
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Republic of Serbia
- University of Belgrade, School of Medicine, Belgrade, Republic of Serbia
| | - Miloš Nikolić
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Republic of Serbia
- University of Belgrade, School of Medicine, Belgrade, Republic of Serbia
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Rodriguez-Lojo R, Castiñeiras I, Sánchez-Blas M, Fernández-Diaz M. Recurrent episodes of periorbital edema in an elderly woman. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Räßler F, Lukács J, Elsner P. Treatment of eosinophilic cellulitis (Wells syndrome) - a systematic review. J Eur Acad Dermatol Venereol 2016; 30:1465-79. [PMID: 27357601 DOI: 10.1111/jdv.13706] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 03/11/2016] [Indexed: 02/06/2023]
Abstract
Eosinophilic cellulitis (Wells syndrome) is a rare inflammatory skin disease defined by erythematous, tender, sometimes urticarial plaques, possibly with vesicles and bullae, and granulomatous eosinophilic infiltrates in the dermis. Usually the disease has a benign course with spontaneous remission within a few weeks. Nevertheless, recurrences are quite frequent and may occur for several years. The objective of this study was to review the so far reported treatment options for Wells syndrome in a systematic manner. This systematic review is based on a search on Medline, Embase and Cochrane Central Register for English and German articles from 1970 to 2015. Advices on the treatment of Wells syndrome are limited predominately to case reports or to small case series. There are no randomized controlled trials, and control groups are missing. A variety of treatment options for Wells syndrome were reported including topical and systemic corticosteroids, antihistamines, cyclosporine, dapsone, azathioprine, griseofulvin, doxycycline, minocycline, antimalarial medications, oral tacrolimus/topical tacrolimus, sulfasalazine, interferon alpha and gamma, TNF alpha inhibitors, colchicine and PUVA therapy. As well-designed, randomized controlled trials are missing, no guidelines for the treatment of this disease can be given. Due to the small number of patients and the frequent misdiagnosis of this clinical entity, the aim of this systematic overview is to call attention to this rare condition and to help clinicians to diagnose and treat Wells syndrome effectively. Due to the good prognosis and tendency to resolve, systemic treatment should be limited to cases resistant to local therapy or with widespread lesions.
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Affiliation(s)
- F Räßler
- Klinik für Hautkrankheiten, Universitätsklinikum, Jena, Deutschland.,Department of Dermatology, University Hospital, Jena, Deutschland
| | - J Lukács
- Klinik für Hautkrankheiten, Universitätsklinikum, Jena, Deutschland.,Department of Dermatology, University Hospital, Jena, Deutschland
| | - P Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum, Jena, Deutschland.,Department of Dermatology, University Hospital, Jena, Deutschland
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Recurrent episodes of periorbital edema in an elderly woman. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:704-6. [PMID: 27216976 DOI: 10.1016/j.ad.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 03/03/2016] [Accepted: 03/12/2016] [Indexed: 11/22/2022] Open
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Abstract
Eosinophilic cellulitis or Wells syndrome is an uncommon skin condition of unknown
etiology that can occur alone or associated with other conditions. Typically, it
presents with recurrent pruritic, erythematous and edematous plaques, but it can also
show clinical polymorphism. Besides the cutaneous lesions, patients can experience
systemic manifestations like fever, malaise, arthralgia and peripheral blood
eosinophilia. We describe a case of this rare syndrome that presented with
polymorphic cutaneous lesions associated with a serious systemic disease, which was
revealed through the investigation of the cutaneous disease.
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Abstract
Eosinophil infiltration can be observed in skin disorders, such as allergic/immunologic, autoimmune, infectious, and neoplastic diseases. Clinical presentations are variable and include eczematous, papular, urticarial, bullous, nodular, and fibrotic lesions; pruritus is a common symptom in all. In this review, we present representative eosinophilic skin diseases according to their clinical pattern, together with histologic findings and diagnostic procedures. We also discuss the potential roles of eosinophils in the pathogenesis of dermatologic disorder. Current pathogenesis-based diagnostic and therapeutic approaches are outlined.
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Affiliation(s)
- Elisabeth de Graauw
- Department of Dermatology, Inselspital, Freiburgstrasse, Bern CH-3010, Switzerland; Institute of Pharmacology, University of Bern, Inselspital, Bern CH-3010, Switzerland
| | - Helmut Beltraminelli
- Department of Dermatology, Inselspital, Freiburgstrasse, Bern CH-3010, Switzerland
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Inselspital, Bern CH-3010, Switzerland
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Freiburgstrasse, Bern CH-3010, Switzerland.
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Cormerais M, Poizeau F, Darrieux L, Tisseau L, Safa G. Wells' Syndrome Mimicking Facial Cellulitis: A Report of Two Cases. Case Rep Dermatol 2015; 7:117-22. [PMID: 26120307 PMCID: PMC4478307 DOI: 10.1159/000432392] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Wells’ syndrome (WS), or eosinophilic cellulitis, is an uncommon inflammatory dermatosis of unknown etiology that typically presents with pruritic cellulitis-like plaques on the extremities. Therefore, WS is often misdiagnosed as bacterial cellulitis due to its similarity in presentation. Here, we report two cases of WS that masqueraded as bacterial facial cellulitis. Under treatment with oral prednisone and/or a combination therapy with levocetirizine and hydroxyzine, both patients showed a dramatic improvement of the skin lesions. These cases highlight the need for clinicians to consider WS in the differential diagnosis when evaluating a patient with facial cellulitis that does not respond to an initial antimicrobial regimen. In addition, our cases suggest that combination therapy with levocetirizine and hydroxyzine may be successfully used as corticosteroid-sparing treatment or to prevent relapse after the discontinuation of corticosteroid treatment.
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Affiliation(s)
- Maxence Cormerais
- Department of Dermatology, Centre Hospitalier de Saint-Brieuc, Saint-Brieuc, Armor Pathology Laboratory, Plérin, France
| | - Florence Poizeau
- Department of Dermatology, Centre Hospitalier de Saint-Brieuc, Saint-Brieuc, Armor Pathology Laboratory, Plérin, France
| | - Laure Darrieux
- Department of Dermatology, Centre Hospitalier de Saint-Brieuc, Saint-Brieuc, Armor Pathology Laboratory, Plérin, France
| | | | - Gilles Safa
- Department of Dermatology, Centre Hospitalier de Saint-Brieuc, Saint-Brieuc, Armor Pathology Laboratory, Plérin, France
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Brun J, Chiaverini C, Bessis D, Bourrat E, Lasek-Duriez A, Hadj-Rabia S, Boralevi F, Lacour JP. [Wells Syndrome in children and atopy: Retrospective study of 11 cases and review of the literature]. Ann Dermatol Venereol 2015; 142:320-31. [PMID: 25846461 DOI: 10.1016/j.annder.2015.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 01/20/2015] [Accepted: 02/04/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Well's syndrome, or eosinophilic cellulitis, is rare in childhood, with fewer than 40 pediatric cases being reported since 1979. The physiopathology is unknown. PATIENTS AND METHODS In February 2012, members of the research group of the Department of Pediatric Dermatology Society submitted their case of Wells' syndrome in children aged 0-15 years. Details of clinical, biological and histological features and of therapeutic strategies were collected by physicians using a standardized questionnaire. Pictures were reviewed by the authors. RESULTS Eleven patients were included (average age: 6 years), with a strong prevalence of atopy (63%). Two types of clinical manifestation were noted: single or multiple cellulitis associated or not with vesiculobullous lesions and fixed urticaria. Eighty-two percent of patients had pruritus and 73% had eosinophilia. For all patients, histological examination of skin biopsies showed an eosinophilic infiltrate extending in the dermis with associated Sweet-like neutrophilic infiltrate being seen in 2 patients. The course of the disease was protracted (mean duration: 8 months) with flare-ups. Treatment varied depending on the doctors (topical or systemic steroids, tacrolimus and dapsone). DISCUSSION Our study confirms some of the data in the literature concerning the clinical, histological features and course of Well's syndrome in children. The key information is the high prevalence of atopic children hitherto unreported. In a setting of insect bites, vaccination, infection or traumatism, this unusual background could explain the onset of inflammatory reaction with eosinophils. Oral or topical steroids appear to be the first-line treatment in children when necessary. CONCLUSION Well's syndrome in children is rare and characterized by its polymorphism. We report for the first time in a series of patients a high prevalence of atopy, which raises new perspectives in understanding these rare diseases. We propose topical steroids as first-line therapy in children with superficial lesions, with oral steroids being given for cellulitic lesions or where topical therapy fails.
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Affiliation(s)
- J Brun
- Dermatologie, hôpital l'Archet 2, CHU de Nice, BP 3079, 06202 Nice cedex 3, France; Pédiatrie, hôpitaux pédiatriques, CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France
| | - C Chiaverini
- Dermatologie, hôpital l'Archet 2, CHU de Nice, BP 3079, 06202 Nice cedex 3, France; Pédiatrie, hôpitaux pédiatriques, CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France.
| | - D Bessis
- Dermatologie, hôpital Saint-Eloi, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - E Bourrat
- Dermatologie, hôpital Robert-Debré, AP-HP, 75935 Paris cedex 19, France
| | - A Lasek-Duriez
- Dermatologie, hôpital Saint-Vincent, CHRU de Lille, 59037 Lille cedex, France
| | - S Hadj-Rabia
- Dermatologie, hôpital Necker, AP-HP, 75015 Paris, France
| | - F Boralevi
- Dermatologie, hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France
| | - J-P Lacour
- Dermatologie, hôpital l'Archet 2, CHU de Nice, BP 3079, 06202 Nice cedex 3, France
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Bokotas C, Kouris A, Stefanaki C, Sgotzou T, Christofidou E, Kontochristopoulos G. Wells syndrome: response to dapsone therapy. Ann Dermatol 2014; 26:541-2. [PMID: 25143695 PMCID: PMC4135121 DOI: 10.5021/ad.2014.26.4.541] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/21/2013] [Accepted: 09/07/2013] [Indexed: 11/19/2022] Open
Affiliation(s)
- Charalambos Bokotas
- Second Department of Dermatology and Department of Venereology, "A. Sygros" Hospital, Athens, Greece
| | - Anargyros Kouris
- Second Department of Dermatology and Department of Venereology, "A. Sygros" Hospital, Athens, Greece
| | - Christina Stefanaki
- Second Department of Dermatology and Department of Venereology, "A. Sygros" Hospital, Athens, Greece
| | - Themis Sgotzou
- Second Department of Dermatology and Department of Venereology, "A. Sygros" Hospital, Athens, Greece
| | | | - George Kontochristopoulos
- Second Department of Dermatology and Department of Venereology, "A. Sygros" Hospital, Athens, Greece
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Porcellato I, Giontella A, Mechelli L, Del Rossi E, Brachelente C. Feline eosinophilic dermatoses: a retrospective immunohistochemical and ultrastructural study of extracellular matrix remodelling. Vet Dermatol 2014; 25:86-94, e26. [PMID: 24666659 DOI: 10.1111/vde.12119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Feline eosinophilic dermatoses (FEDs) are common diseases of cats with an unknown pathogenesis. They are histologically characterized by an eosinophilic infiltration and often by the presence of flame figures (FFs) and/or areas of loss of tissue architecture, here termed necrotic foci (NF). It has been postulated that an alteration in the degradation of the extracellular matrix could be responsible for these histological features. Matrix metalloproteinases (MMPs) are a group of proteases that are fundamental in extracellular matrix remodelling. HYPOTHESIS/OBJECTIVES The aim of the study was to investigate retrospectively the expression of a subgroup of MMPs, in particular MMP-2 and MMP-9 gelatinases, in FEDs. The expression of one of their inhibitors, TIMP-2, was also investigated in order to establish the role of these molecules in the pathogenesis of FEDs. The ultrastructural characteristics of extracellular matrix in FFs and NF were subsequently assessed. METHODS Fifty-one formalin-fixed, paraffin-embedded specimens from cutaneous and mucosal biopsies diagnosed as FEDs were investigated immunohistochemically. Two selected samples were processed for electron microscopy. RESULTS This study revealed an increased expression of MMP-2 in NF and a decreased expression of this gelatinase in FFs. An imbalance between MMP-2 and TIMP-2 was evident using immunohistochemistry. No significative results were observed for MMP-9 expression. Electron microscopy confirmed the lack of normal collagen fibres in NF, whereas in FFs only occasional, amorphous material was observed among normal collagen fibres. CONCLUSIONS AND CLINICAL IMPORTANCE Our study suggests that an imbalance in the expression of matrix metalloproteinases could be responsible for different morphological findings in FEDs. Further studies are needed to assess the role of matrix metalloproteinases in the pathogenesis of FEDs.
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Affiliation(s)
- Ilaria Porcellato
- Department of Veterinary Medicine, University of Perugia, 06126, Perugia, Italy
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Lorente-Lavirgen AI, López-López R, Baquero-Sánchez E, Pulpillo-Ruiz A, De Zulueta-Dorado T, Conejo-Mir J. Pruritic nodules and plaques on the arms with blisters in a patient with chronic lymphocytic leukemia. Int J Dermatol 2014; 53:277-9. [DOI: 10.1111/ijd.12257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Rocío López-López
- Department of Dermatology; Virgen del Rocío University Hospital; Seville Spain
| | - Elena Baquero-Sánchez
- Department of Dermatology; Virgen del Rocío University Hospital; Seville Spain
- Department of Pathology; Virgen del Rocío University Hospital; Seville Spain
| | | | | | - Julian Conejo-Mir
- Department of Dermatology; Virgen del Rocío University Hospital; Seville Spain
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Cinotti E, Rongioletti F. New emerging diseases or syndromes in dermatopathology with impact on clinical management. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.11.75] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Heelan K, Ryan JF, Shear NH, Egan CA. Wells syndrome (eosinophilic cellulitis): Proposed diagnostic criteria and a literature review of the drug-induced variant. J Dermatol Case Rep 2013; 7:113-20. [PMID: 24421864 DOI: 10.3315/jdcr.2013.1157] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/15/2013] [Indexed: 01/30/2023]
Abstract
BACKGROUND Wells syndrome is an uncommon inflammatory dermatosis first described in 1971 by Wells. The clinical eruption is characterized by varying morphology and severity and usually follows a relapsing remitting course. The majority of the reported cases are of unknown etiology, drug induced Wells syndrome has rarely been reported. A literature search using MEDLINE was performed. We recorded the features of our case and of the additional cases of drug induced Wells syndrome in the literature. MAIN OBSERVATIONS Including our case there are 25 cases of drug-induced Wells syndrome reported. Causative drugs include antibiotics, anticholinergic agents, anaesthetics, non-steroidal anti-inflammatory agents, thyroid medications, chemotherapeutic agents, thiomersal containing vaccinations, anti-tumor necrosis factor agents and thiazide diuretics. CONCLUSIONS To the authors knowledge this is the first reported case of drug-induced Wells syndrome from thiazide diuretics. The diagnosis of Wells syndrome is often controversial and we propose a set of diagnostic criteria.
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Affiliation(s)
- Kara Heelan
- Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland; ; Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Canada
| | - John F Ryan
- Department of Histopathology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Canada
| | - Conleth A Egan
- Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland
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Sinno H, Lacroix JP, Lee J, Izadpanah A, Borsuk R, Watters K, Gilardino M. Diagnosis and management of eosinophilic cellulitis (Wells' syndrome): A case series and literature review. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2013; 20:91-7. [PMID: 23730155 DOI: 10.1177/229255031202000204] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Eosinophilic cellulitis (Wells' syndrome) is an inflammatory dermatitis that is often misdiagnosed as infectious cellulitis due to its similarity in presentation. Misdiagnosis leads to delay of correct treatment and inappropriate use of antibiotics. METHODS A case series of eosinophilic cellulitis and a literature review are presented. RESULTS Patients with Wells' syndrome may present with a variety of nonspecific symptoms, such as fever, arthralgia and malaise, as well as myriad cutaneous lesions with associated erythema, presenting as blisters, bullae, papules and/or nodules. Several treatment modalities have been used to treat eosinophilic cellulitis and have been met with variable success rates; these include systemic corticosteroids, topical corticosteroids and antihistamines, with success rates of 91.7%, 50% and 25%, respectively. CONCLUSIONS A high degree of clinical suspicion must be exercised to diagnose this rare condition. Cellulitis with an atypical presentation or not responding to appropriate antibiotic treatment should trigger suspicion of Wells' syndrome. To date, the most successful treatment method is a short course of systemic corticosteroids.
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Cherng E, McClung AA, Rosenthal HM, Hicks J, Levy ML. Wells' syndrome associated with parvovirus in a 5-year old boy. Pediatr Dermatol 2012; 29:762-4. [PMID: 22150362 DOI: 10.1111/j.1525-1470.2011.01619.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Wells' syndrome, otherwise known as eosinophilic cellulitis, is a rare dermatosis seen more commonly in adults than in children. In this article, we present a 5-year-old Caucasian boy who initially presented with pruritic, erythematous macules and papules evolving to bullae formation. Subsequent histology confirmed diagnosis of Wells' syndrome, and additional blood work also demonstrated positive immunoglobulin (Ig)M and IgG for parvovirus. In many instances, the direct etiology of Wells' syndrome is unclear, but the link between parvoviral infection and development of Wells' syndrome could further support an additional cause.
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Affiliation(s)
- Eric Cherng
- Austin Diagnostic Clinic Private Practice, Austin, Texas, USA
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Kim SH, Kwon JE, Kim HB. Successful treatment of steroid-dependent eosinophilic cellulitis with cyclosporine. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2012; 5:62-4. [PMID: 23277881 PMCID: PMC3529232 DOI: 10.4168/aair.2013.5.1.62] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 08/16/2012] [Indexed: 11/20/2022]
Abstract
Eosinophilic cellulitis (EC) is a rare idiopathic disorder, first described as a "recurrent granulomatous dermatitis with eosinophilia", that mimics cellulitis of infectious origin. We describe here a previously healthy 11-year-old girl who experienced fever and tender erythematous patch lesions after trauma to her knees. Because of the relapsing cellulitis-like skin lesions, skin biopsies were taken, resulting in a diagnosis of EC. The patient responded well to oral prednisolone but experienced side effects and relapse during dose tapering. She was switched from prednisolone to cyclosporine. Her EC remained under control, and she showed no evidence of relapse after discontinuation of cyclosporine.
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Affiliation(s)
- Su Hee Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
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Abstract
Many cutaneous conditions can mimic infection. If these lesions are not accurately recognized, they may be treated with antimicrobial agents, which adds cost, potential risk, and inconvenience to the patient and the healthcare system. The presenting signs and symptoms of many ulcerating, pustular, morbilliform, bullous, neoplastic, granulomatous, autoimmune, and neutrophilic conditions, as well as clinical vasculitis, cellulitis, folliculitis, and panniculitis, have been mistaken for infection. This review emphasizes the clinical presentation, physical exam, and diagnostic workup of many of these conditions to assist the clinician in ascertaining the correct diagnosis. In addition, general treatment options are provided for each disease category.
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Affiliation(s)
- Janelle R Ricketts
- Dermatology Department, University of CT Health Center, Farmington, CT 06030, USA.
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Cruz MJ, Mota A, Baudrier T, Guimarães S, Azevedo F. Recurrent Wells' syndrome associated with allergic asthma exacerbation. Cutan Ocul Toxicol 2011; 31:154-6. [PMID: 22035426 DOI: 10.3109/15569527.2011.627523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Wells syndrome is an inflammatory eosinophilic dermatosis of unknown pathogenesis characterized by clinical polymorphism, a suggestive but nonspecific histopathologic traits, usually with a recurrent course and inconstant response to therapy. It seems to be an unspecific hypersensitivity reaction in response to various exogenous and endogenous stimuli, such as insect bites, infections, drug eruption or underlying internal disorders. We present a patient with allergic asthma and atopic dermatitis in whom a skin eruption developed in the sequence of allergic asthma exacerbation, which was clinically and histologically consistent with the diagnosis of eosinophilic cellulitis. The authors discuss the probability of a common pathogenesis and the role of IL-5. To our best knowledge this is the first pediatric case where this association is reported.
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Affiliation(s)
- Maria João Cruz
- Dermatology and Venereology, Hospital São João, Alameda Prof. Hernani Monteiro, Porto, Portugal.
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Eosinophilic annular erythema: An expression of the clinical and pathological polymorphism of Wells syndrome. J Am Acad Dermatol 2011; 65:e135-e137. [DOI: 10.1016/j.jaad.2011.05.049] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 05/04/2011] [Accepted: 05/28/2011] [Indexed: 11/20/2022]
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Rudikoff D. Differential diagnosis of round or discoid lesions. Clin Dermatol 2011; 29:489-97. [PMID: 21855723 DOI: 10.1016/j.clindermatol.2010.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Dermatologists are called on to diagnose a variety of skin conditions in diverse age groups. Dermatologic diagnosis, based on identification of a primary lesion, uses morphologic clues to categorize the pathologic process causing the eruption. In addition, distribution and grouping of lesions helps support a specific diagnosis. Dermatologists consciously or unconsciously use pattern recognition to arrive at their differential diagnosis based on clinical experience and their having previously viewed similarly appearing skin lesions in lectures, texts, and journals. Round and discoid patches and plaques are extremely common in the clinical practice of dermatology. This contribution reviews the dermatologic conditions that present as round or discoid lesions and presents an approach to diagnosis.
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Affiliation(s)
- Donald Rudikoff
- Division of Dermatology, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Bronx, NY 10457, USA.
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Maiberger M, Maher I. JAAD Grand Rounds quiz. Pruritic, recurrent, erythematous plaques. J Am Acad Dermatol 2010; 64:214-6. [PMID: 21167424 DOI: 10.1016/j.jaad.2010.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 02/28/2010] [Accepted: 03/07/2010] [Indexed: 11/25/2022]
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Simon D, Wardlaw A, Rothenberg ME. Organ-specific eosinophilic disorders of the skin, lung, and gastrointestinal tract. J Allergy Clin Immunol 2010; 126:3-13; quiz 14-5. [PMID: 20392477 PMCID: PMC2902687 DOI: 10.1016/j.jaci.2010.01.055] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 01/13/2010] [Accepted: 01/14/2010] [Indexed: 01/09/2023]
Abstract
Eosinophils are multifunctional leukocytes that increase in various tissues in patients with a variety of disorders. Locally, they can be involved in the initiation and propagation of diverse inflammatory responses. In this review the clinical association of eosinophils with diseases of the skin, lung, and gastrointestinal tract is summarized. An approach to determining the causal role of eosinophils in these diseases is presented. Recent findings concerning molecular diagnosis, cause, and treatment are discussed.
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Affiliation(s)
- Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew Wardlaw
- Institute for Lung Health, Department of Infection Immunity and Inflammation, University of Leicester, United Kingdom
| | - Marc E. Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Urticarial lesions: if not urticaria, what else? The differential diagnosis of urticaria: part I. Cutaneous diseases. J Am Acad Dermatol 2010; 62:541-55; quiz 555-6. [PMID: 20227576 DOI: 10.1016/j.jaad.2009.11.686] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 11/02/2009] [Accepted: 11/10/2009] [Indexed: 11/22/2022]
Abstract
UNLABELLED Acute urticaria is self-limiting, and a cause can be identified in many patients. Chronic urticaria is a long lasting disease, and patients are commonly examined for an autoimmune origin and for associated diseases. Although the diagnosis of urticaria is straightforward in most patients, it may pose some difficulties at times and it may require a careful differential diagnosis with a number of conditions. Urticarial syndromes comprise both cutaneous and systemic disorders. Part I of this two-part series focuses on the clinical and histologic features that characterize common urticaria and on the cutaneous diseases that may manifest with urticarial lesions and must be considered in the differential diagnosis. LEARNING OBJECTIVES After completing the learning activity, participants should be able to distinguish between the typical wheals of urticaria and urticarial lesions suggesting other diagnoses and to assess patients with urticarial lesions in order to exclude or confirm other cutaneous diseases.
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Amano H, Nagai Y, Ishikawa O. Persistent urticaria characterized by recurrent lasting urticarial erythema with histological features of prominent perivascular eosinophilic infiltration. Clin Exp Dermatol 2009; 34:e14-7. [DOI: 10.1111/j.1365-2230.2008.02975.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
A 72-year-old man presented with a 1-month history of a rash. The eruption had previously been successfully treated with oral corticosteroids (prednisolone 30 mg/day) and antihistamines on two previous occasions, but recurred several days after stopping treatment. On examination, multiple, indurated, round to annular erythematous plaques were found on the trunk and limbs. Histological examination revealed interstitial oedema, a dense infiltrate of eosinophils in the dermis, and flame figure formation. These results led us to the diagnosis of eosinophilic cellulitis. Treatment with oral corticosteroids (prednisolone 15 mg/day) was unsuccessful. Four weeks after the start of oral tacrolimus 1 mg/day, the eruption completely resolved.
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Affiliation(s)
- T Ohtsuka
- Department of Dermatology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan.
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González Martínez F, Santos Sebástián M, Navarro Gómez M, Saavedra Lozano J, Hernández Sampelayo T. Celulitis eosinofílica: síndrome de Wells. An Pediatr (Barc) 2009; 70:509-11. [DOI: 10.1016/j.anpedi.2009.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 12/18/2008] [Accepted: 01/18/2009] [Indexed: 11/30/2022] Open
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47
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Cho WC, Pai YC, Hsiung Y, Choi WM. Cutaneous Tuberculosis Presenting as Necrotizing Fasciitis in an Elderly Patient. INT J GERONTOL 2008. [DOI: 10.1016/s1873-9598(08)70016-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Zamberk-Majlis P, Velázquez-Tarjuelo D, Cabeza-Martínez R, Hernanz-Hermosa J. Niña con placas eritematoedematosas recurrentes en miembros inferiores. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s0001-7310(08)74661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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49
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Zamberk-Majlis P, Velázquez-Tarjuelo D, Cabeza-Martínez R, Hernanz-Hermosa J. Girl With Recurrent Erythematous Edematous Plaques on Her Legs. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70237-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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50
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Abstract
A síndrome de Wells é dermatose inflamatória benigna rara, de curso recorrente, descrita em todas as idades e sem predileção por sexo, de etiologia e patogênese desconhecidas. Embora sua autonomia seja questionada, a síndrome de Wells é entidade distinta cujo diagnóstico se faz pela combinação de quadro clínico marcante, achados histopatológicos típicos quando associados à clínica, e curso característico.
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