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Author: Dr Fiona Larsen, Dermatology Registrar, Green Lane Hospital, Auckland, New Zealand, 2005.
Eosinophilic cellulitis is a rare condition of unknown cause. It is also called Wells syndrome.
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 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.
Oral corticosteroid treatment with prednisone can lead to a dramatic improvement of eosinophilic cellulitis within days. The course is typically tapered over one month.
Mild cases may respond to topical steroid therapy alone.
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