Wells Syndrome: Clinical Presentation and Literature Review
Main Article Content
Keywords
Eosinophilia, Cellulite , Glucocorticoids, Biopsy
Abstract
Introduction: Eosinophilic cellulitis, also known as Wells syndrome, is a rare inflammatory dermatosis that mimics skin infections such as bacterial cellulitis, often leading to delays in proper diagnosis and treatment. The aim of this report is to present a clinical case of Wells syndrome and review the main clinical, histopathological, and therapeutic findings associated with this condition.
Case report: A 24-year-old female patient with no relevant medical history presented with a two-month history of a dermatosis localized on the right side of the face, characterized by an erythematous-edematous plaque. She was initially treated as a case of infectious cellulitis with antibiotics, without clinical improvement. A skin biopsy was performed, revealing an eosinophilic inflammatory infiltrate with flame figures, confirming the diagnosis of eosinophilic cellulitis. Treatment with prednisone was initiated, resulting in complete resolution of the lesions and no recurrences during follow-up.
Conclusions: Wells syndrome should be considered in patients with chronic inflammatory dermatoses that do not respond to antibiotics. Skin biopsy is essential for diagnosis, and systemic corticosteroids are an effective treatment. Recognizing this entity helps avoid unnecessary treatments and improves prognosis through timely therapeutic intervention.
References
1. Alhubayshi B, Baabdullah A, Gammash M. Eosinophilic cellulitis (Wells syndrome): a case report. Int J Res Dermatol. 2021;7(3):450–453. doi:10.18203/issn.2455-4529.IntJResDermatol20211708
2. Manti M, Pappa E, Arkouli V, et al. Wells syndrome with generalized oedema. EJCRIM. 2023.
3. Almeida J, Boff A. Dupilumab in eosinophilic cellulitis (Wells’ syndrome): a potential new treatment option. J Dtsch Dermatol Ges. 2025;19:1653–1655. doi:10.1016/j.abd.2024.07.010
4. Setiawan M, Abdurrahman N, Muzellina VN. Toxocariasis and Strongyloidiasis as Triggering Factors for Wells' Syndrome. 2024. Disponible en: https://www.researchgate.net/publication/382450424
5. Shah D. Revolutionizing dupilumab treatment in refractory eosinophilic cellulitis: case report and literature review. Cureus. 2023;15:e50333. doi:10.7759/cureus.50333
6. Saǰn M, Luzar B, Zver S. Wells syndrome possibly caused by hematologic malignancy or influenza vaccine. World J Clin Cases. 2022;10(30):10997-11003. doi:10.12998/wjcc.v10.i30.10997
7. Long H, Zhang G, Wang L, et al. Eosinophilic skin diseases review including Wells syndrome. Clin Rev Allergy Immunol. 2016;50(2):189-213. doi: 10.1007/s12016-015-8485-8
8. Sabbe M, Schleich F, Janssens P, et al. Sequential use of mepolizumab and dupilumab in eosinophilic asthma (relevant immunology). J Med Case Rep. 2024; doi:10.1186/s13256-023-04255-8
9. Yeon J, Chan RC, Zagarella S. Eosinophilic cellulitis successfully treated with methotrexate. Australas J Dermatol. 2020;61:e421–e423.
10. Tan LY, Wang D, Lim JS, et al. Eosinophilic cellulitis secondary to occult strongyloidiasis: case report. Am J Med Case Rep. 2021; doi:10.21037/amj-20-150
11. Kim DH, Kim JH, Park HJ, et al. Eosinophilic cellulitis: Clinical features, histopathologic findings, and outcomes of 17 Korean cases. Ann Dermatol. 2011;23(3):304–308. doi:10.5021/ad.2011.23.3.304
12. Rasulova G, Özcanlı A, Büyükbabani N, et al. A rare case of sudden bilateral eosinophilic cellulitis mimicking scleredema: case report and review of infantile cases. Turk J Dermatol. 2024;18(3):99–103. doi:10.4274/tjd.galenos.2024.35744
13. Bao WW, Chow EY. A case report of bullous Wells’ syndrome resolved with terbinafine. Case Rep. 2025; doi:10.7759/cureus.80060
14. Blomberg M, Winther C, Høyrup S, et al. Treatment of widespread eosinophilic cellulitis (Wells’ syndrome) with benralizumab. Acta Derm Venereol. 2020;100(2):adv00332. doi:10.2340/00015555-3697
15. Ahmed A, Ali M, Sharma K, et al. Wells syndrome: emerging triggers and treatments—a systematic review. Clin Rev Allergy Immunol. 2023;65(1):34–42. doi:10.1007/s12016-022-08956-9
16. Heelan K, Ryan JF, Shear NH. Wells syndrome: 15-year retrospective study and review of the literature. J Cutan Pathol. 2018;45(4):274–280. doi:10.1111/cup.13171
17. Traidl S, Angela Y, Kapp A,, et al. Dupilumab in eosinophilic cellulitis (Wells’ syndrome): a case report. J Dtsch Dermatol Ges. 2021;19(11):1653–1655. doi:10.1111/ddg.14598
18. Del Pozo J, García-Silva J, Almagro M, et al. Eosinophilic cellulitis: a diagnostic and therapeutic challenge. Clin Exp Dermatol. 2009;34(6):e246–e249. doi:10.1111/j.1365-2230.2009.03410.x
19. Caputo R, Marzano AV, Vezzoli P, Lunardon L. Wells syndrome in adults and children: a report of 19 cases. Arch Dermatol. 2006 Sep;142(9):1157-61. doi: 10.1001/archderm.142.9.1157. PMID: 16983003.
20. Herout S, Bauer WM, Schuster C, et al. Eosinophilic cellulitis (Wells syndrome) successfully treated with mepolizumab. JAAD Case Rep. 2018;4(6):548–550. doi:10.1016/j.jdcr.2018.02.008