Background

Wells syndrome (eosinophilic cellulitis) is an uncommon condition of unknown etiology. In 1971, George Wells first described this syndrome as a recurrent granulomatous dermatitis with eosinophilia.^[1]In 1979, he and Neil Smith renamed it eosinophilic cellulitis.

The presentation of Wells syndrome usually involves a mildly pruritic or tender cellulitislike eruption with typical histologic features characterized by edema, flame figures, and a marked infiltrate of eosinophils in the dermis.^[2] Papular and nodular eruptions at the clinical presentation have also been reported. The condition can recur and may be preceded by a pruritic papular eruption. Although the syndrome is usually sporadic, some familial cases have been reported.

In a small retrospective study (N = 9), vasculitis, Wells syndrome, and Sweet syndrome occurred in succession in one patient, suggests that these diseases may overlap each other.^[3] Another report described a dominant syndrome consisting of eosinophilic cellulitis, intellectual disability, and abnormal body habitus in one family.^[4]

Of the numerous treatment options available for Wells syndrome,^[5]systemic corticosteroids are the most effective, though they carry a risk of corticosteroid dependence. Other options include topical corticosteroids, calcineurin inhibitors, griseofulvin, H1-receptor antagonists, cyclosporine, and dapsone.

Next: Pathophysiology

Pathophysiology

At least some cases of Wells syndrome may involve hypersensitivity to an arthropod bite or sting.

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Media Gallery

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

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#author-disclosures{display:block}#author-disclosures.modal-layer{position:relative}#author-disclosures .modal-content{max-height:none}#author-disclosures .close-modal{display:none}

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.

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