Which factors increase the risk for Wells syndrome (eosinophilic cellulitis)?

Updated: Mar 26, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

Wells syndrome is usually sporadic, but some familial cases have been described. Suggested precipitating factors include the following:

  • Arthropod bites and stings, including those of the honeybee [18]

  • Cutaneous viral infections; there is a possible link between parvoviral infection and Wells syndrome [19]

  • Cutaneous parasitic infestations, including toxocariasis, [20, 21] ascariasis, [22] and onchocerciasis [23]

  • Leukemia [24]

  • Myeloproliferative disorders

  • Atopic dermatitis

  • Fungal infections

  • Giardiasis [26]

  • Hypersensitivity reactions to medications or metals, including metallic alloy implants [27]

  • Churg-Strauss syndrome: This syndrome has been associated in a few patients [28] ; these reports are noteworthy for the presence of bullae and of antineutrophil cytoplasmic antibodies [29] ; only a few other autoimmune diseases have been associated, including a case report of systemic lupus erythematosus [30] ; sometimes, differentiating between these disorders can be challenging [31] Both Wells syndrome and Churg-Strauss syndrome may have eosinophils and flame figures. It has been postulated that Wells syndrome could represent the initiation of a pathogenetic process fully developed as Churg-Strauss syndrome. [32]


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