What is eosinophilic fasciitis (EF)?

Updated: Dec 24, 2020
  • Author: Peter M Henning, DO; Chief Editor: Herbert S Diamond, MD  more...
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Eosinophilic fasciitis (EF), also called Shulman syndrome, is a rare, localized fibrosing disorder of the fascia. [1] The etiology and pathophysiology are unclear.

In 1974, Shulman provided an early description of eosinophilic fasciitis as a disorder characterized by peripheral eosinophilia and fasciitis that could be differentiated from scleroderma by the distinctive pattern of skin involvement that spares the digits, involves fascia rather than dermis, and is not accompanied by Raynaud phenomenon. [2, 3, 4]

Since 1974, over 300 patients with eosinophilic fasciitis have been reported. [5, 6] Despite this, the current understanding of the disease relies on a relatively few large case series and multiple case reports. Therefore, the understanding of key aspects of the disease continues to evolve.

The etiology of eosinophilic fasciitis remains unknown, although many possible triggers and disease associations have been suggested. Some aspects of pathophysiology have been elucidated; however, a more complete understanding has yet to develop.

The available literature has generated a broader clinical image of the condition, but fascial thickening in the setting of eosinophilia, elevated erythrocyte sedimentation rate, and hypergammaglobulinemia remain critical elements of the syndrome. Visceral involvement in eosinophilic fasciitis is generally absent, a finding that helps differentiate eosinophilic fasciitis from systemic sclerosis and other differential considerations. However, an association with several hematologic diseases is recognized and frequently carries a grave prognosis.

The diagnosis of eosinophilic fasciitis is suspected in a patient presenting with characteristic skin changes and consistent laboratory findings. It is confirmed with full-thickness biopsy or characteristic MRI findings. See Presentation and Workup.

Eosinophilic fasciitis is generally corticosteroid-responsive, and initial treatment regimens are based on this therapy. Multiple additional agents have been used in steroid-refractory disease. The evidence for many of these agents is anecdotal, and there is no general consensus regarding the best agent for treatment of steroid-resistant disease or cases refractory to steroid withdrawal. See Treatment and Medication.

See also Dermatologic Manifestations of Eosinophilic Fasciitis.

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