Eosinophilic cellulitis

Background

• Idiopathic syndrome of eosinophilic infiltration into skin
• Many proposed triggers but none definite

Clinical Manifestations

• Sudden onset large, inflamed edematous patches, often with vesicles or bullae mimicking cellulitis
• Often preceded by pruritus or burning
• Often on trunk and extremities
• Fevers may be absent or low-grade
• Patches evolve over days, and can have central healing while border becomes purple
• Patches regress within about 10 days, with return to normal skin around 4 to 6 weeks
• Typically relapses over months to years, though with good long-term prognosis

Diagnosis

• Biopsy results can vary by age of lesion
  • Dermal infiltration of eosinophils, some with degranulation
    • May be superficial, deep dermal, or hypodermal (e.g. eosinophilic panniculitis)
  • Later, "flame-figures" in mid to deep dermis, consisting of collagen fibres with eosinophilic granules
  • Eosinophils eventually disappear and are replaced by phagocytic granulomas
  • Should not show evidence of vasculitis
• Peripheral eosinophilia in about 50% of patients

Management

• Corticosteroids with prednisone 0.5 to 1 mg/kg/day followed by rapid taper
• Dapsone
• Antihistamines