Reflections on Eosinophils and Flame Figures

Workshop report from the National Institutes of Health Taskforce on the Research Needs of Eosinophil-Associated Diseases (TREAD)

“…Whether Wells syndrome is a specific entity that is triggered by factors including underlying disease, infection, and drugs, or whether it is merely a reaction pattern is difficult to discern from the reported cases and in practice. 30 Association of eosinophilic cellulitis with a range of disorders suggests that it is a reactive or allergic hypersensitivity phenomenon.…”

Exaggerated arthropod assault: Eosinophilic dermatosis in a patient with small lymphocytic lymphoma

“…However, flame figures are not pathognomonic for Well's syndrome and have since been observed in a variety of eosinophilic dermatoses, including arthropod bites, bullous pemphigoid, eczema, scabies infestations, hypereosinophilic syndromes, and drug reactions 2, 3, 8. This histopathology has also been observed among patients with hematological malignancies, owing to the high numbers of eosinophils seen in tissue specimens 1, 2, 5.…”

“…In the case of CLL, the pathophysiology is yet to be fully understood; however, it is thought to occur as the result of a type IV delayed hypersensitivity reaction, as the cutaneous lesions are rich in T cells in addition to eosinophils, leading to the hypothesis that such a reaction represents an exaggerated response to arthropod bites 2, 4, 5, 6, 8. This was illustrated in a case of 8 patients with CLL who developed significant dermal reactions from exposure to mosquito antigen versus control patients 9.…”

“…Similar to Wells Syndrome, conservative treatment of these lesions with topical steroids often yields disappointing results and requires systemic steroids at a dose of at least 40 mg/d, or in cases refractory to systemic steroids, treatment directed at the underlying malignancy 1, 2, 5, 6, 8, 10. The patient was unable to recall any significant arthropod bites or exposures; however, given the history of spending a large portion of his time outdoors during the summer months prior to the development of his cutaneous lesions, an exaggerated arthropod response was determined to represent the most likely diagnosis.…”

Eosinophilic cellulitis (Wells syndrome): diagnostic features

“…Буллезные поражения могут содержать эозинофилы и в большинстве случаев являются субэпидермальными. Несмотря на то что эозинофилия, гистиоцитарный инфильтрат и «языки пламени» являются характерными признаками ЭЦУ при гистологическом исследовании, они также могут быть обнаружены при ряде других заболеваний, таких как буллезный пемфигоид, экзема, грибковая инфекция, везикулярный дерматит, чесотка и укусы насекомых [28].…”