Eosinophilic cellulitis: symptoms, causes and treatment

Eosinophilic cellulitis, also known as Wells’ syndrome, is a rare skin disease that mainly affects adult men and women. The disease is characterized by redness, swelling, warmth, red bumps, hives and/or blisters. The rash appears suddenly, lasts for a few weeks and often returns repeatedly. It is not normally associated with scarring. As of 2023, it is not known what causes eosinophilic cellulitis. It is suspected to be an autoimmune reaction. Possible triggers of this reaction include insect bites, such as those from spiders, fleas or ticks, and the use of certain medications or undergoing surgery. Spontaneous healing can take months to years.

  • What is eosinophilic cellulitis?
  • Who gets it?
  • Symptoms
  • Causes
  • Triggering factors
  • Examination and diagnosis
  • Diagnosis upon exclusion
  • Differential diagnosis
  • Therapy
  • Prognosis
  • Prevention

 

St Thomas’ Hospital / Source: Photographer and original uploader was Adrian Pingstone at en.wikipedia, Wikimedia Commons (Public domain)

What is eosinophilic cellulitis?

Eosinophilic cellulitis is a rare condition with an (as of 2023) unknown cause. It is also called Wells’ syndrome. It was first described by George Crichton Wells (July 13, 1914 – January 16, 1999) in 1971. Wells was a dermatologist at St. Thomas’ Hospital and St. Johns Hospital for Diseases of the Skin, both based in London. By the way, it was Florence Nightingale (May 12, 1820 – August 13, 1910), the famous British nurse and social reformer, who founded the world’s first professional nursing school at St. Thomas’ Hospital in 1860.

Who gets it?

Eosinophilic cellulitis affects adults more often than children, and men and women get it equally often.

Symptoms

Often, eosinophilic cellulitis is preceded by localized itching or burning skin. Swollen nodules and painful plaques develop. The spots are often bright red initially, often look like cellulitis (an acute bacterial infection of the skin) and then fade over four to eight weeks, leaving green, gray or brown spots. Blisters may appear. The rash most commonly occurs on the arms and legs, but can also affect the trunk. You often feel very tired and you have roughly a 1 in 4 chance of fever.

Initial rash in eosinophilic cellulitis / Source: Ioannis D Bassukas, Georgios Gaitanis, Aikaterini Zioga, Christina Boboyianni and Christina Stergiop, Wikimedia Commons (CC BY-2.0)

Causes

In 2023, it is unclear what causes eosinophilic cellulitis. It is suspected that it is an autoimmune reaction, or an immune reaction against the body’s own substances.

Triggering factors

Possible triggers of eosinophilic cellulitis include:

  • insect bites (spider bite, bee sting, flea bite, tick bite or mite bite)
  • viral infections
  • parasitic infections
  • leukemia
  • myeloproliferative disorders (where the bone marrow produces too many red blood cells, white blood cells and/or platelets)
  • atopic eczema
  • fungal infections
  • certain types of medications
  • operations
  • EGPA (Eosinophilic Granulomatosis with Polyangiitis, until recently called Churg-Strauss Syndrome, abbreviated as CSS)

 

Examination and diagnosis

Diagnosis upon exclusion

The diagnosis is made after other possible causes have been ruled out. Eosinophilic cellulitis is a diagnosis made by exclusion of alternative diagnoses. Skin biopsy of the affected areas may show an increased number of eosinophils (certain type of white blood cells).

Hives on a leg / Source: Templeton8012, Wikimedia Commons (CC BY-SA-3.0)

Differential diagnosis

The following skin conditions must be ruled out by the doctor:

  • erysipelas or erysipelas
  • bacterial cellulitis
  • urticaria or hives
  • delayed pressure urticaria
  • urticarial vasculitis
  • toxicoderma
  • insect bites
  • parasitic infection
  • contact allergic eczema
  • morphea
  • erythema elevatum diutinum
  • granuloma annulare
  • bullous pemphigoid
  • hypereosinophilic syndrome
  • Churg-Strauss syndrome
  • Sweet syndrome
  • cutaneous lymphoma

 

The treatment of eosinophilic cellulitis is often done with corticosteroids / Source: Michaeljung/Shutterstock.com

Therapy

The treatment of eosinophilic cellulitis is often done with corticosteroids (adrenocortical hormone). This can be applied as a cream or taken orally. Oral intake is actually only done if the rash covers a large area and it does not improve with other interventions. The doctor can prescribe antihistamines to reduce itching. Often the rash disappears after a few weeks to months without treatment.

Prognosis

The long-term prospects are excellent. The condition usually resolves over four to eight weeks and can disappear more quickly with treatment, often without leaving scars. In some affected people the rash may return, but recurrence is fairly common. In recurrent cases it can take years before it is finally under control.

Prevention

Since the cause of eosinophilic cellulitis has not been clarified, it is not yet possible in 2023 to take preventive measures to prevent this.

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