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Wells Eosinophilic Cellulitis | Annular eosinophilic erythema

Definition: three signs plus blood eosinophilia
  • Inflammatory lesions
  • Sclerodermiform lesions that follow them
  • A non-specific but suggestive histological pattern known as “flame figure”
 
Etiology and Mechanism: unknown
  • Proposed: local hypersensitivity to “trigger”
  • Activated Th2 cells
  • IL5
 
Clinical presentation
  • Prodromal itching or burning
  • → markedly edematous plaques
    • May be misdiagnosed as erysipella or acute cellulitis
  • Por vezes recorrentes e associados a eosinofilia perifĂ©rica
  • Pode ter figuras anulares
 
Histology
  • Figuras em chama - resultam da desgranulação de eosinĂłfilos - mas muitos DDx
  • Microabcesso de Langerhans na epiderme
  • Intersticial dermal infiltrate of eosinophils
  • Characteristic brightly eosinophilic flame figure (collagen fibers coated with eosinophil granule proteins → evidĂȘncia de desgranulação)
      • notion image
 
Treatment
  • Prednisone (10-80mg daily, taper over 1 month)
  • Minocycline,
  • Colchicine,
  • Antimalarials,
  • Dapsone
  • Griseofulvin
  • Interferon alpha
  • Antihistmines
  • Dupilumab
  • Omalizumab
  • Mepolizumab, Benralizumab
      • notion image
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