Recurrent Granulomatous Dermatitis with Eosinophilia

A 27-year-old womsn developed J chronic, recurrent eruption of the face and upper extremities with the clinicai and histopathologic features of recurrent granulomatous dermatitis with eosinophilia (Wells' syndrome). As described in 15 previously reported cases, this disorder is characterized by two clinical phase!> (eosinophilic cellulitis and granulomatous plaque phase) and three histopathologic stages. The latler are particularly remarkable for a diffuse dermal and subcutaneous eosinophilia in acute lesions and scattered flame figures in chronic lesions. Distinctive findings in this case were the predominance of facial involvement and the symptomatic response to topical corticostvroids. Although etiology and pathogenesis are unknown, we feel that Wells' ^^yndrome is a unique yet rarely recognized clinicopalhologic entity. Recurrent granulomatous dermatitis with eosinophilia was first described by Wells.' He reported four patients with an "obscure, recurrent dermatosis which combines a striking clinical picture with a very remarkable histopathology."' These patients had an eruption consisting of two clinical phases. The first phase, designated an eosinophilic cellulitis, was described as a rapidly spreading, poorly demarcated area of erythema and edema that occasionally blistered. The inflammation could involve a small area on the trunk or an extremity or expand to involve an entire limb. In the second phase, occurring Address for reprints: Andrew J. Mitchell. M.D., Department of Dermatology, Henry Ford Hospital, Detroit, Ml 48202. 1-3 weeks following the onset of eosinophilic cellulitis, there was a gradual metamorphosis of the acute "cellulitis" into a plaque of indurated, slate-colored skin. Eventually these skin changes completely resolved without residual scarring. In this report we describe an additional case of recurrent granulomatous dermatitis with eosinophilia. Our patient both reinforces and augments the spectrum of cutaneous changes that can occur in this disorder. We feel that the clinical and histopathological findings in Wells' syndrome are unique and yet rarely recognized in the American literature.