Eosinophilic infiltration with flame figures. A distinctive tissue reaction seen in Wells' syndrome and other...

We report five cases, all male, of diverse clinical findings of scattered erythematous, violaceous, or centrally blue plaques. Eight biopsies from the five patients showed nodular or diffuse dermal and subcutaneous infiltration, predominantly of eosinophils and histiocytes, with "flame figures" composed of granules of eosinophils that surround collagen bundles, whose staining quality is thereby altered. Two patients were children, the younger only 18 months old. Three patients initially presented clinical evidence of insect bites, and in one of these the biopsy showed cutaneous pseudolymphoma underlying dermal changes of eosinophilic cellulitis. Eosinophilic infiltration with flame figures is a distinctive reaction to various stimuli. It may be seen in a wide variety of clinical conditions and is not confined solely to patients with Wells' syndrome, which may be an acceptable term for clinically typical cases. Eosinophilic infiltration with flame figures is preferred descriptively to identify the microscopic changes in Wells' syndrome and in other cases like that of our patient with pseudolymphoma, in which the cutaneous reaction may be secondary to some other disease.