Eosinophillic Dermatoses

Question 1

T/F : A Flame figue is a collagen fibre coated with eosinophil granules

Answer 1

True

Question 2

What are the eosinophilic dermatoses?

Answer 2

Common:
* Allergic contact dermatits
* Anthropod bite reaction
* Atopic Dermatits
* Drug eruption
* Erythema toxicum neonatorum
* Parasitic infections
* scabies
* urticaria

Less common:
* eosinophilic fascitis
* eosinophilc folliculitis
* granuloma faciale
* hypereosinophillic syndromes
* cutaneous mastocytosis
* BP
* Pruritic polymorophic eruption of pregnancy
* wells
* urticarial dermatisi
— many more

Question 3

What is Wells syndrome?

Answer 3

Also called eosinophilic cellulitis

A rare cutaneous disorder of unknown etiology characterised by one or more edematous (early) to indurated (late) plaques that resemble well-demarcated cellulitis.

Question 4

What are the clinical features of Wells syndrome?

Answer 4

Recurrent episodes of prodromal itching or burning, accompanied by markedly edematous plaques.

Plaques:
* Annular or arcuate configuration.
* Vesicles and bullae may be seen
* bright red, and then they fade to
a pink–brown or slate-gray color
* can become indurated

Lesions resovle over 4 - 6 weeks

Generally affect the extremitis (trunk can be affected)

Malaise and sometimes fever

Question 5

Describe the clincial features

Answer 5

intensely erythematous and oedematous plaque on the anterior shin

Well demarcated - pink / grey plaques with erosions on the volar wrist

Question 6

What is the histopathology of Wells Syndrome?

Answer 6

Intraepidermal or subepidermal blisters

Diffuse dermal eosinophils, lymphocytes, and histiocytes

Flame figures in the dermis (bright eosinophilic areas of
collagen encrusted with eosinophil granules)

Question 7

Labe this Diagram

Answer 7

Flame Figure
Lymphocytes
Eosinophil

Question 8

What are the arrowheads pointing to?

Answer 8

Flame figures

Question 9

DDx of Wells syndrome

Answer 9

Bacterial cellulitis
Erysipelas
Morphea
EAC

Question 10

Treatment of wells syndrome?

Answer 10

First line:
* prednisone 10–80mg daily
* taper dose over one month
* tends to have an excellent response

Second line:
* minocycline,
* colchicine, antimalarials,
* dapsone
* griseofulvin
* Interferon alpha
* Antihistamines

Reports of response to dupilimab and omalizumab, mepolizumab (IL-5)