Life of Lesions in Eosinophilic Cellulitis (Wells' Syndrome)—A Condition That May Be Missed at First Sight

Abstract

Eosinophilic cellulitis is an inflammation of, until now, unknown etiology that was first described by George Wells in 1971. Its dominating histological hallmarks are so-called "flame figures" and an eosinophilic infiltrate. Here, we report the case of a 46-year-old man who initially presented with excoriated papules that were histologically interpreted as consistent with "arthropod reactions." Later on, the clinical presentation changed to erythematous plaques, partially with cockade-like aspects. At this time, new biopsies were performed showing a superficial and deep perivascular lymphocytic and heavily eosinophilic infiltrate and flame figures, thus allowing to establish the diagnosis of Wells' syndrome. Under treatment with oral prednisolone and dapsone, the patient showed a rapid improvement of the condition. The presented case demonstrates both the clinical and histopathologic life of lesions of Well's syndrome in the course of the disease from unspecific to distinctive. The need for repeated biopsies is discussed. Current understanding of the pathogenesis of Wells' syndrome and its correlating histological features are elucidated.