Wells Syndrome: A Rare Recurrent Eosinophilic Dermatosis in a Tertiary Care Hospital

Wells syndrome, a rare eosinophilic cutaneous disorder, also called eosinophilic cellulitis, exhibits significant clinical heterogenicity. It typically presents as erythematous infiltrated plaques, primarily on the extremities. Initially, these lesions often exhibit similarities to erysipelas or cellulitis but do not respond to antimicrobial therapy. Contribution of IL-5, abnormal Th2 cells, and activated eosinophilic granulocytes suggests a nonspecific hypersensitivity reaction to exogenous or endogenous stimuli. Wells syndrome is a diagnosis of exclusion that can be recognised by its clinical course, and histological findings. Corticosteroids are the mainstay treatment, helps alleviate the ongoing, relapsing pattern. We are reporting a case of 50 years old male presented to us with complaint of itchy red raised lesions that has recurrent course. On physical examination, multiple erythematous plaques were identified over bilateral lower limb. Skin biopsy specimen was sent for histopathological examination which showed eosinophilic infiltration around peri-appendageal structures confirming the diagnosis of Wells syndrome. It is a rare, relapsing skin disorder of unknown cause which is difficult to diagnose specially on first episode. For mild cases, topical corticosteroids are often sufficient. However, in most of the cases, oral steroids show rapid resolution. Gradual reducing dosage of corticosteroids across a month is usually easily tolerated by the patients whereas low maintenance dose with corticosteroids helps in preventing recurrences.