Site Under Construction

Wells’ syndrome in an 18-year-old Filipino female: a case report

Jarische Frances S. Lao-Ang, MD and Claudine Yap-Silva, MD, FPDS



Wells’ syndrome, also known as eosinophilic cellulitis, is a rare inflammatory dermatosis that mostly affects adults and manifests as recurrent erythematous papules, vesicles, and nodules. With predilection sites that may vary and clinical presentation that may mimic other cutaneous diseases, it can be misdiagnosed and eventually mismanaged. Hence, it is important for dermatologists to warrant the need to investigate further when faced with a recurrent dermatitis such as Wells’ syndrome.


Case Report

This is a case of an 18-year-old Filipino female with no known comorbidities, who presented with a three year history of recurrent erythematous papules, vesicles, and nodules over her bilateral side of the chin. She was initially managed as a case of infected acne vulgaris, and was given oral antibiotics such as Cloxacillin, Rifampicin, and Clarithromycin, but with minimal improvement. She was then referred to Dermatology service for further evaluation. A 3-mm skin punch biopsy on an erythematous nodule on the left chin was done, and histopathologic findings were diffuse eosinophilic infiltrates, exhibiting flame figures admixed with few lymphocytes and neutrophils, consistent with Wells’ syndrome, otherwise known as eosinophilic cellulitis. Serology also revealed elevated IgE level at 949.2 IU/mL but normal eosinophil count. Patient was then given oral corticosteroid for eight weeks, resulting in complete resolution of lesions and no residual scarring.



Wells’ syndrome is a rare dermatitis and it is usually misdiagnosed with other more common cutaneous diseases, most often than not with bacterial cellulitis. When confronted with a cutaneous lesion that is not responding to treatment, a dermatology referral is warranted. Various treatment modalities for Wells’ syndrome exist, such as systemic corticosteroids, systemic immunomodulators, and topical application of steroid or tacrolimus. Among the aforementioned treatment options, systemic corticosteroid is still considered the first-line therapy because it provides good therapeutic response and complete clearance of skin lesions.


  1. Sinno, H., Lacroix, J.-P., Lee, J., Izadpanah, A., Borsuk, R., Watters, K., & Gilardino, M. Diagnosis and management of Wells’ syndrome: A case series and literature review. The Canadian Journal of Plastic Surgery 2012; 20(2), 91–97
  2. Philippine Dermatologic Society Health Information System data. Retrieved : August 2017.
  3. Cormerais, M., Poizeau, F., Darrieux, L., Tisseau, L., & Safa, G. Wells’ Syndrome Mimicking Facial Cellulitis: A Report of Two Cases. Case Reports in Dermatology 2015; 7(2), 117–122.
  4. Heelan K, Ryan JF, Shear NH, Egan CA. Wells syndrome (eosinophilic cellulitis): proposed diagnostic criteria and a literature review of the drug- induced variant. J Dermatol Case Rep 2013; 7:113–120.
  5. Tassava T, Rusonis PA, Whitmore SE. Recurrent vesiculobullous plaques. Eosinophilic cellulitis (Wells syndrome). Arch Dermatol 1997;133 (1580– 1):1583–1584.
  6. Herr H, Koh JK. Eosinophilic cellulitis (Wells’ syndrome) successfully treated with low-dose cyclosporine. J Korean Med Sci 2001;16:664–668.26.
  7. Bokotas C et al. Wells syndrome: response to dapsone therapy. Ann Dermatol 2014; 26: 541–542.
  8. Dereure O., and Guilhou JJ. Eosinophilic-like erythema: a clinical subset of Wells’ eosinophilic cellulitis responding to antimalarial drugs. Ann. Dermatol. Venereol. 2002;129:720–3.
  9. Moossavi M, and Mehregan DR. Wells’ syndrome: a clinical and histopathologic review of seven cases. Int J Dermatol 2003;42:62–67.
  10. Verma P, Singal A,and Sharma S. Idiopathic bullous eosinophilic cellulitis (Wells syndrome) responsive to topical tacrolimus and antihistamine combination. Indian J Dermatol Venereol Leprol 2012; 78:378–380.
  11. Reabler ,F., Lukacs,J. and Elsner,P. Review Article: Treatment of eosinophilic cellulitis (Wells syndrome) – a systematic review Journal of European Academy of Dermatology and Venereaology March 2016.

REquesting Permission

Wells’ syndrome in an 18-year-old Filipino female: a case report