Recurrent granulomatous dermatitis with eosinophilia. Wells' syndrome

A 27-year-old woman developed a chronic, recurrent eruption of the face and upper extremities with the clinical and histopathologic features of recurrent granulomatous dermatitis with eosinophilia (Wells' syndrome). As described in 15 previously reported cases, this disorder is characterized by two clinical phases (eosinophilic cellulitis and granulomatous plaque phase) and three histopathologic stages. The latter are particularly remarkable for a diffuse dermal and subcutaneous eosinophilia in acute lesions and scattered flame figures in chronic lesions. Distinctive findings in this case were the predominance of facial involvement and the symptomatic response to topical corticosteroids. Although etiology and pathogenesis are unknown, we feel that Wells' syndrome is a unique yet rarely recognized clinicopathologic entity.