WHAT IS EOSINOPHILIC CELLULITIS AND HOW TO TREAT THEM ?

 EOSINOPHILIC CELLULITIES :



Eosinophilic cellulitis, also known as wells syndrome  to be  confused  with weil's is a skin disease that presents  with painful , red  , raised , and warm patches of skin . The  rash comes on suddenly , lasts  for a few weeks . anf often  repeatedly comes back . Scar formation does not typically occur.  Eosinophilic cellulitis is of unknown cause. It may  be  triggered  by bites from insects such as spiders , fleas or ticks , or from medication or surgery . Other conditions that may appear  similar include  cellulitis , contact dermatitis , and severe allergic rection such as anaphylaxis. 

Treatment is often with a corticosteroids. Steroids applied as a cream is generally  recommended  over the use of steriods by mouth. Many times the condition  goes away after a few weeks without treatments . it affects both sexes withthe same frequency . it was first described by George Crichton Wells in 1971 . 


WHAT ARE THE CAUSES OF EOSINOPHILIC CELLULITIS ? 



The cause of eosinophilic cellulitis  is unknown . it is believed to be a local  hypersensitivity rection . Most cases appear to be idiopathic. Implicated  trigger or associations include :

- Infection 
- Arthropod bite 
- medications and immunisations 
- Haematological disorders and malignancies 

What are the features of eosinophilic cellulitis ?

Eosinophilic cellulitis usually presents  as itchy or burning erythematous  nodules  or plaques resembling  cellulitis  or erysipelas on a limb . However, the clinical appearances is variable : lesions can be single or multiple, the face and trunk may be affected , and clinical  morphology can include : 

- Plaque type 
- Annular granuloma - like 
- Urticaria - like 
- Papulovesicular 
- Bullous 
- Papulonodular 
- Fixed drug eruption - like 

The classic plaque - type variants of eosinophilic cellulitis is the most common presentation  in children , whereas the annular granuloma like variant is more frequently seen in adults . Individuals lesion can resolve spontaneously but typically recur . 

What are the treatments of eosinophilic cellulitis ? 



Eosinophilic cellulitis rapidly responds to an oral corticosteroid , such as prednis one , but often relapses when the steroid dose is reduced .
Other treatments used may included :

- Topical corticosteroid 
- Ciclosporin 
- Dapsone 
- Methotrexate 
Treatments of an  associated trigger , such as cessation of an implcated  drug , can lead to complete resolution . 

How is eosinophilic cellulitis diagnosed ?

Eosinophilic cellulitis is often misdiagnosed  initially as cellulitis often misdiagnosed intially as cellulitis or erysipelas , ans is only considered when antibiotic treatment is unhelpful . 
Proposed diagnostic criteria for eosinophilic  cellulitis  require at least 2 major and one mionor certeria . 

MAJOR CRITERIA :
- clinical picture to include any of the  reported varients 
- no evidence  of systemic disease 
- relapsing ,remitting course 
- histology comprises  eosinophilic infiltrates without vasculities . 

MINOR CRITERIA :
- peripheral eosinophilia not presistent and  not greater than 
- histology has granulomatous change 
- flame figures 
- a triggering factor { eg, a drug }

Peripheral eosinophilia affects approximately 50% of cases but is not required  for diagnoses. 
skin biopsy is usually required and the histological findings depend on the stage of disease . 

  • Key findings in the acute phase are dermal oedema with an eosinophilic  infiltrate and without vasuculitis .
  • The subacute phase shows the  characteristics  "flame figures ". 
  • The chronic phase is granulomatous with histiocytes and giant cells well syndrome pathology. 

What are the differential diagnosis for eosinophilic cellulitis ?

The differential diagnosis for eosinophilic cellulitis may include : 

- Bacterial cellulitis and erysipelas 
- Parasitic infestation 
- Eosinophilic graulomatosis with polyangiitis  
- Arthropod bite 


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