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An Approach to Skin Diseases Associated with Eosinophilia
Eosinophilic skin disorders are encountered frequently in both inpatient and outpatient settings. The cause might be allergic, autoimmune bullous, infectious, hematologic, or hypereosinophilic syndromes, and workups should vary depending on the clinical presentation.
In a retrospective study, investigators reviewed records from 453 patients with rashes and eosinophilia who were referred to a Swiss dermatology clinic. Mild eosinophilia (500–1000 cells/µL) generally was seen in younger atopic patients who had eczema or infectious diseases, such as cutaneous larva migrans or scabies. Moderate eosinophilia (1000–1500 cells/µL) was associated most often with generalized skin lesions that often blistered, age >70, and autoimmune bullous disease. Severe eosinophilia (>1500 cells/µL) usually was associated with hypereosinophilic syndrome, drug hypersensitivity, or malignancy (especially chronic lymphocytic leukemia). Patients with severe eosinophilia often had other abnormalities, such as abnormal blood counts, elevated lactate dehydrogenase, and abnormal computed tomography findings.
This classification was very imprecise, but it does give us a framework to care for patients with eosinophilic dermatoses. Younger patients with mild eosinophilia and an eczematous rash can be treated with a course of topical steroids, as long as infectious agents are excluded. Older patients with moderate eosinophilia should have skin biopsies, especially when the rash is bullous or vasculitic. And older patients with severe blood eosinophilia should have their medications carefully reviewed, along with a more thorough, immediate workup, especially if they have symptoms such as fever, weight loss, fatigue, malaise, or laboratory abnormalities or hepatosplenomegaly.
Radonjic-Hoesli S et al.
Title: Characteristics of dermatological patients with blood eosinophilia: A retrospective analysis of 453 patients.
Source: J Allergy Clin Immunol Pract 2022 May ; [e-pub]. (Abstract/FREE Full Text)