Wells syndrome

Author: Dr Fiona Larsen, Dermatology Registrar, Green Lane Hospital Auckland.

What is Wells syndrome?

Wells syndrome is a rare condition of unknown cause. It is also called ‘eosinophilic cellulitis’.

What does Wells syndrome look like?

Typically the rash is preceded by itching or burning skin and consists of markedly swollen nodules and plaques (lumps) with prominent borders. The patches are usually bright red at first, frequently looking like cellulitis, then fade over four to eight weeks, leaving green, grey or brown patches. They can blister. The rash most commonly occurs on the limbs, but may also affect the trunk.

The patient often feels very tired and has a fever in approximately 25% of cases.


A blood count may reveal increased numbers of white blood cells called eosinophils – these are often associated with allergy or insect bites.

The diagnosis of Wells syndrome can be established by a skin biopsy finding of typical histopathological features with many eosinophils and characteristic ‘flame figures’. However, flame figures are not diagnostic of Wells syndrome and can be seen in other conditions that have increased numbers of eosinophils.

An important part of the management of patients with Wells syndrome is to exclude underlying causes such as parasitic disoders (e.g. a worm infestation) or an allergic contact dermatitis with the help of the appropriate tests.


Oral corticosteroid treatment with prednisone can lead to a dramatic improvement within days and the course is typically tapered over one month. Other treatments include minocycline, dapsone, griseofulvin, ciclosporin and oral antihistamines.

Mild cases may respond to topical steroid therapy alone.

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