Low-dose alternate-day prednisone for persistent Wells' syndrome

Coldiron, B. M.

doi:10.1001/archderm.125.12.1625

Cited by 15 publications

(11 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Most cases resolve after a single course of systemic corticosteroid therapy; when recurrences occur, however, alternative treatments should be considered, to avoid the side effects of chronic systemic steroid therapy. 36 Topical steroid treatment has also been reported as successful therapy, both alone 2,29,39 and in combination with systemic steroid therapy. 5 Specifically, topical steroid therapy alone resolved skin lesions for 2 children, which suggests that topical steroid therapy may be a safe alternative to systemic corticosteroid therapy in the pediatric age group.…”

Section: Discussionmentioning

confidence: 99%

Bullous “Cellulitis” With Eosinophilia: Case Report and Review of Wells' Syndrome in Childhood

Gilliam¹,

Bruckner

Howard³

et al. 2005

Pediatrics

View full text Add to dashboard Cite

ABSTRACT. A 1-year-old girl presented with acute onset of edematous erythematous plaques associated with bullae on her extremities and accompanied by peripheral eosinophilia. She was afebrile, and the skin lesions were pruritic but not tender. The patient was treated with intravenously administered antibiotics for presumed cellulitis, without improvement. However, the lesions responded rapidly to systemic steroid therapy. On the basis of lesional morphologic features, peripheral eosinophilia, and cutaneous histopathologic features, a diagnosis of Wells' syndrome was made. Wells' syndrome is extremely rare in childhood, with 27 pediatric cases reported in the literature. Because it is seen so infrequently, there are no specific guidelines for evaluation and management of Wells' syndrome among children. W ells' syndrome, or eosinophilic cellulitis, is a rare, recurrent, inflammatory dermatosis of unknown pathogenesis. In 1971, Wells 1 described 4 patients with an acute pruritic dermatitis clinically resembling bacterial cellulitis but with histopathologic findings characterized by dermal eosinophilia, phagocytic histiocytes, and the presence of flame figures. He initially called this syndrome recurrent granulomatous dermatitis with eosinophilia but later simplified the name to eosinophilic cellulitis. 2 Wells' syndrome is seen more commonly among adults but has been observed among children. Some hypothesize that this syndrome may represent a hypersensitivity response to a circulating antigen. 2 Associated precipitants include insect bites, medication reactions, recent immunization, myeloproliferative disorders, malignancies, and infections. We describe a case of a young child with no identifiable triggering factors, and we review the evidence for evaluation and management of these pediatric cases. CASE REPORTA previously healthy, 1-year-old girl presented with acute onset of edematous erythematous plaques, with associated bullae, on her lower extremities and left arm (Fig 1). These lesions were pruritic but not painful, and the patient was afebrile. Her parents denied a history of insect bites, ingestion of medications, trauma, or other intercurrent illness. The patient's most recent immunizations had been received 3 months earlier. The patient did not have a history of asthma, and there was no family history of asthma or atopic disease.The patient was admitted with presumed bacterial cellulitis and was treated with intravenously administered oxacillin, without improvement. Her laboratory studies were significant for an elevated white blood cell count of 30 ϫ 10 9 cells per L, with peripheral eosinophilia of 48%. After the patient failed to respond to systemically administered antibiotics, examination of vesicle fluid was performed and revealed numerous eosinophils. Subsequently, the diagnosis of probable Wells' syndrome was made. Oral steroid therapy was started at 2 mg/kg, and the patient's cutaneous symptoms improved within 24 hours, leaving residual erythema and hyperpigmentation (Fig 2). Five days after the i...

show abstract

Section: Discussionmentioning

confidence: 99%

Bullous “Cellulitis” With Eosinophilia: Case Report and Review of Wells' Syndrome in Childhood

Gilliam¹,

Bruckner

Howard³

et al. 2005

Pediatrics

View full text Add to dashboard Cite

show abstract

“…Colchicine and dapsonc have positive but incomplete action. Systemic corticosteroids at variable doses (10-80 mg per day) produce the best results [6], In persistent disease, the prolonged use of low dose (5 mg) alternate-day prednisone can be a useful tool with rel atively low risk [15].…”

Section: Discussionmentioning

confidence: 99%

Wells’ Syndrome: Report of 2 Cases

Paquet

Laso-Dosal²,

Brassinne³

1992

Dermatology

View full text Add to dashboard Cite

Wells’ syndrome is a rare dermatological disease whose origin remains uncertain. Based on clinical, biological and etiological data, it might be recognized as a major form of urticaria. The triggering factors are numerous and unspecific. As revealed by the 51Cr-EDTA test which measures intestinal permeability, the lesions do not seem to be caused by an excess of antigens passing through the intestinal mucosa.

show abstract

“…17 Low-dose therapy with 1 mg prednisolone per kg per day was also reported with good results. 18 Although a topical and systemic therapy with steroids is quite successful in the treatment of Wells syndrome, a long-time use may cause side-effects such as diabetes, hypertonia or gastritis. Successful combination of oral steroids with antihistamines to spare steroids has been described.…”

Section: Topical and Systemic Steroidsmentioning

confidence: 99%

Treatment of eosinophilic cellulitis (Wells syndrome) – a systematic review

Räßler

Lukács

Elsner

2016

Acad Dermatol Venereol

View full text Add to dashboard Cite

Eosinophilic cellulitis (Wells syndrome) is a rare inflammatory skin disease defined by erythematous, tender, sometimes urticarial plaques, possibly with vesicles and bullae, and granulomatous eosinophilic infiltrates in the dermis. Usually the disease has a benign course with spontaneous remission within a few weeks. Nevertheless, recurrences are quite frequent and may occur for several years. The objective of this study was to review the so far reported treatment options for Wells syndrome in a systematic manner. This systematic review is based on a search on Medline, Embase and Cochrane Central Register for English and German articles from 1970 to 2015. Advices on the treatment of Wells syndrome are limited predominately to case reports or to small case series. There are no randomized controlled trials, and control groups are missing. A variety of treatment options for Wells syndrome were reported including topical and systemic corticosteroids, antihistamines, cyclosporine, dapsone, azathioprine, griseofulvin, doxycycline, minocycline, antimalarial medications, oral tacrolimus/topical tacrolimus, sulfasalazine, interferon alpha and gamma, TNF alpha inhibitors, colchicine and PUVA therapy. As well-designed, randomized controlled trials are missing, no guidelines for the treatment of this disease can be given. Due to the small number of patients and the frequent misdiagnosis of this clinical entity, the aim of this systematic overview is to call attention to this rare condition and to help clinicians to diagnose and treat Wells syndrome effectively. Due to the good prognosis and tendency to resolve, systemic treatment should be limited to cases resistant to local therapy or with widespread lesions.

show abstract

Low-dose alternate-day prednisone for persistent Wells' syndrome

Cited by 15 publications

References 0 publications

Bullous “Cellulitis” With Eosinophilia: Case Report and Review of Wells' Syndrome in Childhood

Bullous “Cellulitis” With Eosinophilia: Case Report and Review of Wells' Syndrome in Childhood

Wells’ Syndrome: Report of 2 Cases

Treatment of eosinophilic cellulitis (Wells syndrome) – a systematic review

Contact Info

Product

Resources

About