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Eosinophilic Skin Diseases: A Comprehensive Review

Clinical Reviews in Allergy & Immunology volume 50, pages 189–213 (2016)Cite this article

Abstract

Eosinophilic skin diseases, commonly termed as eosinophilic dermatoses, refer to a broad spectrum of skin diseases characterized by eosinophil infiltration and/or degranulation in skin lesions, with or without blood eosinophilia. The majority of eosinophilic dermatoses lie in the allergy-related group, including allergic drug eruption, urticaria, allergic contact dermatitis, atopic dermatitis, and eczema. Parasitic infestations, arthropod bites, and autoimmune blistering skin diseases such as bullous pemphigoid, are also common. Besides these, there are several rare types of eosinophilic dermatoses with unknown origin, in which eosinophil infiltration is a central component and affects specific tissue layers or adnexal structures of the skin, such as the dermis, subcutaneous fat, fascia, follicles, and cutaneous vessels. Some typical examples are eosinophilic cellulitis, granuloma faciale, eosinophilic pustular folliculitis, recurrent cutaneous eosinophilic vasculitis, and eosinophilic fasciitis. Although tissue eosinophilia is a common feature shared by these disorders, their clinical and pathological properties differ dramatically. Among these rare entities, eosinophilic pustular folliculitis may be associated with human immunodeficiency virus (HIV) infection or malignancies, and some other diseases, like eosinophilic fasciitis and eosinophilic cellulitis, may be associated with an underlying hematological disorder, while others are considered idiopathic. However, for most of these rare eosinophilic dermatoses, the causes and the pathogenic mechanisms remain largely unknown, and systemic, high-quality clinical investigations are needed for advances in better strategies for clinical diagnosis and treatment. Here, we present a comprehensive review on the etiology, pathogenesis, clinical features, and management of these rare entities, with an emphasis on recent advances and current consensus.

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Acknowledgments

We thank Guiying Yu from our department for her help in the preparation of histological sections for the cases presented. We thank Christopher Chang, MD, from Thomas Jefferson University, for his critical review and comments on the manuscript. This work was supported by the National Natural Science Foundation of China (No. 81210308042, 81220108017, 30972745 and 81301357), the National Basic Research Program of China (973 Plan) (2009CB825605), the Hunan Provincial Natural Science Foundation of China (13JJ4025), the programs of Science-Technology Commission of Hunan Province (2011FJ2007, 2011TP4019-7, 2012WK3046 and 2012TT2015), the Fundamental Research Funds for the Central Universities and the National Key Clinical Speciality Construction Project of National Health and Family Planning Commission of the People’s Republic of China.

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The authors have no conflicts of interest to declare pertaining to this article.

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Authors and Affiliations

  1. Department of Dermatology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, 410011, China

    Hai Long, Guiying Zhang & Qianjin Lu

  2. Department of Stomatology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China

    Ling Wang

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Long, H., Zhang, G., Wang, L. et al. Eosinophilic Skin Diseases: A Comprehensive Review. Clinic Rev Allerg Immunol 50, 189–213 (2016). https://doi.org/10.1007/s12016-015-8485-8

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Keywords

  • Eosinophilic dermatoses
  • Eosinophilic cellulitis (Wells syndrome)
  • Granuloma faciale
  • Eosinophilic pustular folliculitis
  • Recurrent cutaneous eosinophilic vasculitis (RCEV)
  • Eosinophilic fasciitis (Shulman disease)