Successful treatment of steroid-dependent eosinophilic cellulitis with cyclosporine.

Jan 2013

Kim SH, Kwon JE, Kim HB.

Source

Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea.

Abstract

Eosinophilic cellulitis (EC) is a rare idiopathic disorder, first described as a "recurrent granulomatous dermatitis with eosinophilia", that mimics cellulitis of infectious origin. We describe here a previously healthy 11-year-old girl who experienced fever and tender erythematous patch lesions after trauma to her knees. Because of the relapsing cellulitis-like skin lesions, skin biopsies were taken, resulting in a diagnosis of EC. The patient responded well to oral prednisolone but experienced side effects and relapse during dose tapering. She was switched from prednisolone to cyclosporine. Her EC remained under control, and she showed no evidence of relapse after discontinuation of cyclosporine.

Full text

NIH - Allergy Asthma Immunology Res

see also:

Wells Syndrome

Treatment of Recalcitrant Eosinophilic Cellulitis With Adalimumab

Sept 2012

Kavita Y. Sarin, MD, PhD; David Fiorentino, MD, PhD

Arch Dermatol. 2012;148(9):990-992. doi:10.1001/archdermatol.2012.114

Eosinophilic cellulitis is a rare condition characterized by recurrent pruritic or tender skin lesions. Biopsies usually display characteristic histologic features of dermal edema, eosinophils, and flame figures (collections of degranulated eosinophilic material). Eosinophilic cellulitis typically responds well to systemic steroids. However, oral steroids may be contraindicated in some patients. In addition, long-term use of systemic steroids can lead to steroid dependence as well as adverse effects on bone density, wound healing, and metabolism. Recent evidence in mice suggests that the tumor necrosis factor (TNF) pathway may play a role in antigen-specific IgE production and eosinophil recruitment. This suggests that TNF inhibitors may have some efficacy in the treatment of eosinophilic cellulitis.

Full Text Article with Diagnostic Images:

Archives of Dermatology

Distinguishing cellulitis from its mimics.

August 2012

Keller EC, Tomecki KJ, Chadi Alraies M.

Source

FACP, Department of Hospital Medicine, A13, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; alraiec@ccf.org.

Key points

Cellulitis is rarely bilateral.

Patients with cellulitis often have systemic symptoms, such as fever and leukocytosis.

A chronic course points to a diagnosis other than cellulitis.

Plaques with a “bound-down” appearance or dark pigmentation point to a chronic disease rather than cellulitis.

Stasis dermatitis is the most common mimic of cellulitis.

MORE THAN 10% OF PATIENTS labeled as having cellulitis do not have cellulitis.¹ This is unfortunate, as it leads to excessive and incorrect use of antibiotics and to delays in appropriate therapy.²However, it is not surprising, given the number of conditions that bear a striking similarity to cellulitis. A familiarity with the features of true cellulitis and with the handful of conditions that can bear a striking similarity to it is the way out of this potential diagnostic quagmire.

Abstract

Distinguishing true cellulitis from its many imitators is challenging but critical if we are to avoid unnecessary use of antibiotics and delays in treatment. Common imitators of cellulitis are stasis dermatitis, lipodermatosclerosis, contact dermatitis, lymphedema, eosinophilic cellulitis, and papular urticaria. Specific criteria do not exist for the diagnosis of cellulitis, but the alert physician can find clues in the history and physical examination that point toward cellulitis.

WHAT CELLULITIS IS—AND IS NOT

The key characteristics of cellulitis are redness, warmth, tenderness, and swelling of the skin. A history of trauma and pain in the affected area and evidence of leukocytosis³ suggest cellulitis. A symmetric or diffusely scattered pattern indicates a condition other than cellulitis, which is overwhelmingly unilateral, with smooth, indistinct borders^4,5 Other factors pointing to cellulitis are underlying immunosuppression, a more rapid progression, previous episodes, systemic symptoms (eg, fever, leukocytosis), new medications, new travel or outdoor exposure, and comorbidities such as diabetes and peripheral vascular disease. A long-standing, slowly progressive course and a history of unsuccessful treatment with antibiotics are strong indicators of a condition other than cellulitis.

Consultation with a dermatologist is recommended to narrow the differential diagnosis. The dermatologist can determine if biopsy is necessary, as many dermatoses that mimic cellulitis can be diagnosed by visual recognition alone.

Important full text article: Cleveland Clinic Journal of Medicine

Oral tacrolimus treatment for refractory eosinophilic cellulitis.

Oral tacrolimus treatment for refractory eosinophilic cellulitis.
Clin Exp Dermatol. 2009 Jun
Ohtsuka T.
Department of Dermatology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan.

A 72-year-old man presented with a 1-month history of a rash. The eruption had previously been successfully treated with oral corticosteroids (prednisolone 30 mg/day) and antihistamines on two previous occasions, but recurred several days after stopping treatment. On examination, multiple, indurated, round to annular erythematous plaques were found on the trunk and limbs. Histological examination revealed interstitial oedema, a dense infiltrate of eosinophils in the dermis, and flame figure formation. These results led us to the diagnosis of eosinophilic cellulitis. Treatment with oral corticosteroids (prednisolone 15 mg/day) was unsuccessful. Four weeks after the start of oral tacrolimus 1 mg/day, the eruption completely resolved.

WileyInterScience

Eosinophilic cellulitis (wells' syndrome) in association with angioimmunoblastic lymphadenopathy.

Eosinophilic cellulitis (wells' syndrome) in association with angioimmunoblastic lymphadenopathy.
Acta Derm Venereol. 2007

Renner R, Kauer F, Treudler R, Niederwieser D, Simon JC.
Department of Dermato-Venereology and Allergology, University of Leipzig.

Eosinophilic cellulitis (Wells' syndrome) is an uncommon inflammatory disease with clinical polymorphism. It is often associated with infectious, allergic or myeloproliferative diseases; however, the exact aetiology is unknown. This report describes a rare case of eosinophilic cellulitis in association with angioimmunoblastic lymphadenopathy. The typical skin findings of Wells' syndrome disappeared completely following chemotherapy and autologous stem cell transplantation.

Acta Dermato-Venereologica