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Eosinophilic cellulitis

Author: Dr Fiona Larsen, Dermatology Registrar, Green Lane Hospital, Auckland, New Zealand, 2005.

Eosinophilic cellulitis — codes and concepts

What is eosinophilic cellulitis?

Eosinophilic cellulitis is a rare condition of unknown cause. It is also called Wells syndrome.

What does eosinophilic cellulitis look like?

Typically eosinophilic cellulitis is preceded by itching or burning skin. It presents with markedly swollen nodules and plaques (lumps) with prominent borders. The patches are usually bright red at first, frequently looking like cellulitis, then fade over four to eight weeks, leaving green, grey or brown patches. They can blister. The rash most commonly occurs on the limbs, but may also affect the trunk.

The patient often feels very tired and has a fever in approximately 25% of cases.

Eosinophilic cellulitis

How is eosinophilic cellulitis diagnosed?

Eosinophilic cellulitis is not often diagnosed clinically until the results of skin biopsy are available.

The diagnosis is established by the finding of typical histopathological features (see eosinophilic cellulitis pathology) with many eosinophils and characteristic ‘flame figures’. However, flame figures are not diagnostic of eosinophilic cellulitis and can be seen in other conditions that have increased numbers of eosinophils. 

A blood count may also reveal increased numbers of eosinophils – these are commonly associated with allergy or insect bites.

Underlying causes of eosinophilia such as parasitic disorders should be excluded (eg, a worm infestation of the bowel). Allergic contact dermatitis may be considered and excluded by patch testing.

What is the treatment of eosinophilic cellulitis?

Oral corticosteroid treatment with prednisone can lead to a dramatic improvement of eosinophilic cellulitis within days. The course is typically tapered over one month.

Other treatments include minocycline, dapsone, griseofulvin, ciclosporin and oral antihistamines.

Mild cases may respond to topical steroid therapy alone.

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