Abstract
Wells syndrome (eosinophilic cellulitis), a rare dermatosis that arises from a multitude of triggers, may present with pruritic and erythematous plaques, papules, vesicles, or blisters.1 We present a case of Wells syndrome that was successfully treated with omalizumab. A 39-year-old female presented with a three-year history of diffusely located pruritic papules. After a negative lab and infectious workup, a punch biopsy showed dense eosinophilic infiltrate in the dermis as well as “flame figure” formation. Unsuccessful trials of prednisone, cetirizine, hydroxyzine, and dapsone prompted the use of omalizumab, which yielded excellent control of symptoms. Omalizumab’s success in the Wells syndrome disease process may be explained by its anti-inflammatory effects on IgE autoantibodies and receptors.5 Few cases of Wells syndrome treated with omalizumab have been reported. Thus, increased research to thoroughly elucidate omalizumab’s pharmacological mechanism of action in this particular disease process is warranted and would be a valuable contribution to the Wells syndrome literature.
Highlights
Wells syndrome is a rare dermatosis characterized by pruritic and erythematous plaques, papules, vesicles, or blisters that commonly appear on the extremities
We present a case of Wells syndrome that was unresponsive to corticosteroids, antivirals, antibiotics, antihistamines, and dapsone
Said “flame figures” represent aggregates of major basic protein released from eosinophils which disintegrate the structural integrity of surrounding collagen and subsequently destroy local tissue.[1]
Summary
Wells syndrome (eosinophilic cellulitis) is a rare dermatosis characterized by pruritic and erythematous plaques, papules, vesicles, or blisters that commonly appear on the extremities. This case reflects one of the few reported instances of Wells syndrome that was successfully treated with omalizumab.
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