The most common and effective treatment are oral steroids, most often oral prednisone 2 mg/kg per day for one week, then tapered over two to three weeks. For cases of persistent and frequently recurrent eosinophilic cellulitis, Coldiron et al suggest a therapeutic approach of low-dose (5 mg) alternate-day oral prednisone. Topical corticosteroids also demonstrated efficacy, but should be considered in cases of limited diseases or for residual lesions. There are two cases in the literature of successful treatment of steroid-resistant Wells’ syndrome with low-dose cyclosporine, suggesting the use of cyclosporine for recalcitrant disease. Antihistamines can be administered to relieve pruritus, but they are ineffective in clearing cutaneous lesions. Dapsone, a medication with both antibacterial and anti-inflammatory properties, has been used effectively alone and as an adjunct to systemic steroids to spare the negative side effects of long-term high-dose steroid use. For cases of eosinophilic cellulitis with an underlying cause, treating the underlying condition has led to resolution of the syndrome, such as treatment of an associated viral infection with acyclovir (33) or an underlying malignancy with radiation therapy. Even with appropriate therapy, patients can expect multiple recurrences.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383552/
Wells syndrome is a rare disease, so only a small number of cases have been reported. Due to the few anecdotal reports and the periodic course of the disease with exacerbations and remissions over years, which may resolve spontaneously, it is difficult to conclude whether a therapy is truly effective or whether an observed recurrence is due to the natural history of the disease. Spontaneous resolution of disease is mostly seen in 4–5 weeks’ time. Because of its tendency to recurrences, Wells syndrome requires an extended and possibly repeated therapy. If a causative factor triggering Wells syndrome can be identified, the best treatment option is to eliminate the underlying condition of the disease. Antiviral therapy in a patient with herpes simplex virus type 2 infection and Wells syndrome led to complete remission of the lesions. The causative treatment, if possible, also applies to malignant diseases. In a colon cancer patient, a hemicolectomy was the only effective treatment to clear the patient’s symptoms. If no precipitating factor can be detected, the first-line treatment option should be topical and/or systemic corticosteroids. Multiple treatment regimens have been used with variable success rates. Most cases resolve after a short course of systemic corticosteroids. If the disease recurs or if there are any contraindications to the use of steroids, alternative therapies are warranted. Topical steroids are a safe and successful alternative to systemic steroids, especially in children and cases with limited skin affection. The highest rate of resolution was reported using oral steroids, about 2 mg/kg/day for 1–2 weeks, then tapered over 2–3 weeks. An alternate day low-dose prednisolone therapy (5 mg) also showed satisfactory effects. Combination treatments such as antihistamines plus systemic prednisolone or topical steroids are sometimes helpful. https://isitforme.health/browse/dx/wells-syndrome/article/synonyms?pmid=27357601
Because of its rarity, no controlled trials on Wells syndrome treatments are available. Topical and systemic corticosteroids, i.e., oral prednisone at the initial dose of 0.5–1 mg/kg/day, are the mainstay of treatment, while cyclosporine A (3–5 mg/kg/day) and dapsone are less frequently described as possible therapeutic options. In our experience, the immunomodulating agent dapsone at a dose of 0.5–1.5 mg/kg/day works well in most patients, theoretically via inhibiting eosinophil recruitment and activation.
Successful treatments with the monoclonal antibodies omalizumab (anti-IgE) and mepolizumab (anti-IL-5) have been anecdotally reported. https://isitforme.health/browse/dx/wells-syndrome/article/synonyms?pmid=32394361
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