Eosinophilic Dermatoses: Recognition and Management

Am J Clin Dermatol. 2020 Aug;21(4):525-539. doi: 10.1007/s40257-020-00520-4.

Abstract

Eosinophilic dermatoses encompass a broad spectrum of diseases of different etiologies hallmarked by eosinophilic infiltration of the skin and/or mucous membranes, with or without associated blood eosinophilia. The wide range of dermatological manifestations of this spectrum, including nodules and plaques, pustules, blisters, ulcers, and urticarial lesions, is reflected in a non-univocal classification system. We identified six groups of eosinophilic dermatoses based on the predominant anatomic level of involvement: (1) epidermal; (2) of the dermal-epidermal junction; (3) dermal; (4) of the hypodermis and muscle fascia; (5) of the pilosebaceous unit; and (6) vascular/perivascular. We review clinicopathologic features and management of diseases belonging to each group, particularly: (1) pemphigus herpetiformis and atopic dermatitis as prototypes of the epidermal group; (2) bullous pemphigoid as prototypic eosinophilic dermatosis of the dermal-epidermal junction; (3) eosinophilic cellulitis (Wells syndrome), hypereosinophilic syndromes, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, eosinophilic dermatosis of hematologic malignancy and chronic spontaneous urticaria as paradigmatic dermal eosinophilic dermatoses; (4) eosinophilic fasciitis as an eosinophilic dermatosis with predominant involvement of the hypodermis and muscle fascia; (5) eosinophilic pustular folliculitis as a model of the pilosebaceous unit involvement; and (6) granuloma faciale, angiolymphoid hyperplasia with eosinophilia, and eosinophilic granulomatosis with polyangiitis, belonging to the vascular/perivascular group.

Publication types

  • Review

MeSH terms

  • Biological Products / therapeutic use
  • Biomarkers / analysis
  • Dermatologic Agents / therapeutic use
  • Eosinophilia / diagnosis*
  • Eosinophilia / immunology
  • Eosinophilia / pathology
  • Eosinophilia / therapy*
  • Eosinophils / immunology
  • Humans
  • Immunohistochemistry / methods
  • Immunosuppressive Agents / therapeutic use
  • Phototherapy / methods
  • Skin / immunology
  • Skin / pathology
  • Skin Diseases / diagnosis*
  • Skin Diseases / immunology
  • Skin Diseases / pathology
  • Skin Diseases / therapy*
  • Treatment Outcome

Substances

  • Biological Products
  • Biomarkers
  • Dermatologic Agents
  • Immunosuppressive Agents