Wells' Syndrome Associated with Molluscum Contagiosum in a Child: A Case Report / 대한피부과학회지

Wells' syndrome or eosinophilic cellulitis is usually observed in adults who present with pruritic, erythematous and edematous plaques associated with papules or vesicles. It is a rare inflammatory dermatosis of unknown etiology showing an eosinophil-mediated immune response. Classical histopathological features observed in patients are eosinophil-predominant inflammatory infiltration and marked dermal edema, along with ‘flame figures’. An 11-year-old boy presented with edematous plaques surmounted by vesicles on his abdomen and lower extremities. A month prior to presentation, these skin lesions occurred on other parts of his abdomen; however, they resolved spontaneously within a week. Skin biopsies from the recurrent lesions showed features consistent with Wells' syndrome and a few molluscum bodies in the epidermis. Laboratory tests showed peripheral eosinophilia. We concluded that Wells' syndrome in this young patient was caused by preceding molluscum contagiosum infection.

A Case of Eosinophilic Cellulitis in a Child / 대한피부과학회지

No abstract available.

Successful Treatment of Steroid-Dependent Eosinophilic Cellulitis With Cyclosporine

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.

Bullous Eosinophilic Cellulitis Caused by Trauma / 대한피부과학회지

Eosinophilic cellulitis is also called Wells' syndrome, and this is an acute pruritic dermatitis that resembles cellulitis. It usually appears as well-circumscribed erythematous plaques, but bullous lesions have rarely been reported. There are several precipitating factors, including drugs, arthropod bites, viral infections, parasitic infestations, leukemia and other malignancies. A 21-year-old male presented with a mildly pruritic vesiculobullous eruption on the dorsum of left foot after he had been pricked by a twig. Histopathologic examination showed intraepidermal blisters and spongiosis of the epidermis and a mixed inflammatory cell infiltration that consisted mostly of eosinophils throughout the dermis. These findings were consistent with the diagnosis of bullous eosinophilic cellulitis. He was treated daily with prednisolone 30 mg and the lesions rapidly resolved. There has been no recurrence of the lesions for 1 year of follow-up.

Bullous Eosinophilic Cellulitis (Wells' Syndrome) in a Patient with Churg-Strauss Syndrome: A Case Report and Review of Literatures / 대한류마티스학회지

Wells' syndrome is an inflammatory dermatosis with associated aberrant eosinophil responses caused by unknown factors. Its histology is characterized by erythematous plaques with "flame figures" in the dermis, which is potentially diagnostic but not pathognomic. Cases of Wells' syndrome in patients with Churg-Strauss syndrome (CSS), which is characterized by antineutrophil cytoplasmic antibody-related necrotizing vasculitis, marked peripheral eosinophilia, and eosinophil tissue infiltrates, have rarely been reported, and the pathogenic association between these two diseases remains undetermined. Differences of clinical and histopathologic features of these two diseases suggest that they are distinct disease entities, even though, in part, they share pathogenic mechanisms. Here we present a new case with Wells' syndrome in a patient with CSS, treated with systemic steroid.

A Case of Bullous Eosinophilic Cellulitis / 대한피부과학회지

Eosinophilic cellulitis is a rare recurrent inflammatory dermatosis, characterized clinically by well-circumscribed erythematous plaques. The histopathologic features of the lesions are dermal edema, infiltration of eosinophils and development of 'flame figures' in the dermis. A 64-year-old female presented pruritic erythematous plaques, with associated bullae, on her right hand and wrist. Histopathologic examination showed infiltration of eosinophils and characteristic flame figures in the dermis. The clinical presentation and histopathologic alterations are consistent with the diagnosis of eosinophilic cellulitis. Herein, we report a case of bullous eosinophilic cellulitis which is an uncommon variant of eosinophilc cellulitis.

A Case of Eosinophilic Cellulitis in an 8-year-old Child / 대한피부과학회지

Eosinophilic cellulitis is a rare, recurrent dermatosis which was first described by Wells in 1971. The etiology and pathogenesis of eosinophilic cellulitis are currently unknown, but a type IV hypersensitivity to various antigens followed by vascular damage seems to play a role in the pathogenesis of eosinophilic cellulitis. Most cases of eosinophilic cellulitis occur in adults. Only 29 cases have been reported in children. Generally, pediatric cases are recurrent but show good response to systemic steroids. We present a case of eosinophilic cellulitis in an 8-year-old boy. Who presented with acute onset of erythematous plaques on both thighs. These lesions were pruritic but not painful. A skin biopsy specimen showed dense mixed inflammatory infiltrations that consisted mostly of eosinophils, lymphocytes and histiocytes. Flame figures surrounded by eosinophils and histocytes and foci of degenerated collagen bundles were observed in the dermis. The lesions resolved rapidly after the initiation of oral steroid therapy. After 6 months, the patient has not experienced recurrence of the disease.

Three Cases of Wells' Syndrome / 대한피부과학회지

Wells' syndrome was first described by Wells in 1971 as a recurrent granulomatous dermatitis with eosinophilia and was later named eosinophilic cellulitis. It is defined by the following criteria: sudden onset of annular or circinate erythematous-edematous patches that rapidly evolve to morphea-like blue-slate-colored plaques; a histological feature characterized usually by the presence of 'flame figures'; non-constant blood hypereosinophilia. We present clinical and histopathologic features of three cases of eosinophilic cellulitis.

A Case of Wells' Syndrome in a Child / 대한피부과학회지

Wells' syndrome, or eosinophilic cellulitis, is characterized clinically by an acute dermatitis resembling cellulitis, which evolves into violaceous plaques that resolve spontaneously without scarring. The histopathologic features show dermal eosinophil infiltration and development of characteristic `flame figure'. Wells' syndrome has been described mainly in adults, and less than 20 childhood cases have been reported. We herein report a case of Wells' syndrome in a 3-year-old boy.

Eosinophilic Cellulitis (Wells' Syndrome) Successfully Treated With Low-dose Cyclosporine

Eosinophilic cellulitis (Wells'syndrome) is an uncommon skin disorder. We report two adult male patients who had recurrent erythematous plaques and a nodular lesion on the abdomen. The histopathologic feature of their skin biopsies similarly indicated a marked infiltrate of eosinophils in the dermis with the fashion of "flame figures". One of the patients demonstrated blood eosinophilia. Given the clinicohistological findings, the patients fulfilled the criteria for the diagnosis of eosinophilic cellulitis. The skin lesions remained refractory to medications such as corticosteroids, sulfones, antihistamines, and minocycline. Considering the beneficial effect of cyclosporine in the treatment of eosinophilia-associated dermatoses, we speculated that eosinophilic cellulitis might respond to cyclosporine therapy. Thus, each of the two patients was given cyclosporine (microemulsion formulation) at a daily dose of 1.25 or 2.5 mg/kg, i.e., 100 or 200 mg, respectively. Complete remission of the skin eruptions was obtained in both patients during a 3- or 4-week period of treatment. No side effects were observed. Neither of the patients experienced relapse of the disease at least over 10 months after the discontinuation of the cyclosporine therapy. We suggest that administration of low-dose cyclosporine be a safe and useful therapeutic option in patients with eosinophilic cellulitis.

A Case of Wells' Syndrome Treated with Systemic PUVA / 대한피부과학회지

Wells' syndrome, or eosinophilic cellulitis, is characterized by recurrent cutaneous swellings which resemble acute bacterial cellulitis, and by distinctive histopathological changes. Skin lesions show dermal eosinophilic infiltration and the characteristic 'flame figures', but not pathognomonic, which are composed of eosinophil major protein deposited on collagen bundles. A 51-year-old woman developed a chronic, pruritic, erythematous to dark-brown colored, annular, infiltrated plaques with papules, vesicles and some crusts on the chest, abdomen, back and both forearms with the clinical and histological features of Wells' syndrome. Skin lesions had recurred frequently with systemic corticosteroids therapy, so we tried systemic PUVA and treated her successfully without recurrence until now.

A Case of Wells' Syndrome Treated with Systemic PUVA / 대한피부과학회지

Wells' syndrome, or eosinophilic cellulitis, is characterized by recurrent cutaneous swellings which resemble acute bacterial cellulitis, and by distinctive histopathological changes. Skin lesions show dermal eosinophilic infiltration and the characteristic 'flame figures', but not pathognomonic, which are composed of eosinophil major protein deposited on collagen bundles. A 51-year-old woman developed a chronic, pruritic, erythematous to dark-brown colored, annular, infiltrated plaques with papules, vesicles and some crusts on the chest, abdomen, back and both forearms with the clinical and histological features of Wells' syndrome. Skin lesions had recurred frequently with systemic corticosteroids therapy, so we tried systemic PUVA and treated her successfully without recurrence until now.

Eosinophilic Cellulitis (Wells' Syndrome)

Eosinophilic cellulitis is a rare dermatosis first described by Wells, and characterized by recurrent episodes of sudden outbreaks of erythematous cutaneous swellings often painful or pruritic. Microscopically, the lesion shows diffuse tissue eosinophilia and fibrinoid flame figures, evolution of associated focal necrobiosis, and formation of focal microgranulomas associated with eosinophils. The cause is still unknown but the triggers which have been thought to precipitate the disease include insect bites, parasitic infections such as toxocara, onchocerciasis, nasopharyngeal carcinoma, rheumatoid arthritis and spider bites. However many cases are idiopathic. The author experienced a case of eosinophilic cellulitis of a 52-year-old woman with multiple cutaneous tender plaques of cellulitis for approximately 10 years with history of repeated remission and recurrent episodes. Biopsy was taken from ulcerated edematous nodule of inguinal region under the clinical impression of deep fungal infection, pyoderma gangrenosum and polyarteritis nodosa. Cultures for fungal and common organisms were negative. Histologically, the entire dermis was infiltrated by numerous eosinophils and scattered histiocytes. There were scattered flame figures showing necrobiotic foci in the collagen with accumulation of eosinophils, granulated free cosinophilic granules and histiocytes.

Eosinophilic Cellulitis (Wells' Syndrome)

Eosinophilic cellulitis is a rare dermatosis first described by Wells, and characterized by recurrent episodes of sudden outbreaks of erythematous cutaneous swellings often painful or pruritic. Microscopically, the lesion shows diffuse tissue eosinophilia and fibrinoid flame figures, evolution of associated focal necrobiosis, and formation of focal microgranulomas associated with eosinophils. The cause is still unknown but the triggers which have been thought to precipitate the disease include insect bites, parasitic infections such as toxocara, onchocerciasis, nasopharyngeal carcinoma, rheumatoid arthritis and spider bites. However many cases are idiopathic. The author experienced a case of eosinophilic cellulitis of a 52-year-old woman with multiple cutaneous tender plaques of cellulitis for approximately 10 years with history of repeated remission and recurrent episodes. Biopsy was taken from ulcerated edematous nodule of inguinal region under the clinical impression of deep fungal infection, pyoderma gangrenosum and polyarteritis nodosa. Cultures for fungal and common organisms were negative. Histologically, the entire dermis was infiltrated by numerous eosinophils and scattered histiocytes. There were scattered flame figures showing necrobiotic foci in the collagen with accumulation of eosinophils, granulated free cosinophilic granules and histiocytes.

A Case of Eosinophilis Cellulitis (Wells' Syndrome) / 대한피부과학회지

Eosinophilic cellutitis occurred in an otherwise healthy 38-year-old woman. The patient had 4 months history of extremely pruritic erythematous wheal-like lesions on the extremities with blood eosinophilia. The individual lesions persisted for up to 12 weeks and responded well to systemic corticosteroid therapy. Elistopathologically the lesion showed diffuse tissue eosinophilia, histiocytic granuloma and characteristic flame figures in the dermis.