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Eosinophilic fasciitis
Eosinophilic fasciitis
Other names	Shulman syndrome
Specialty	Rheumatology

Eosinophilic fasciitis (/ˌiːəˌsɪnəˈfɪlɪk ˌfæʃiˈaɪtɪs, ˌiːoʊ-, -ˌfæsi-/^[2]^[3]), also known as Shulman's syndrome,^[4] is an inflammatory disease that affects the fascia, other connective tissues, surrounding muscles, blood vessels and nerves. Unlike other forms of fasciitis, eosinophilic fasciitis is typically self-limited and confined to the arms and legs, although it can require treatment with corticosteroids, and some cases are associated with aplastic anemia.^[5]

The condition was first characterized in 1974,^[6] but it is not yet known whether it is actually a distinct condition or merely a variant presentation of another syndrome. The presentation is similar to that of scleroderma or systemic sclerosis. However, unlike scleroderma, eosinophilic fasciitis affects the deeper fascial layers, rather than the dermis; the characteristic and severe effects of scleroderma and systemic sclerosis, such as Raynaud's syndrome, involvement of the extremities, prominent small blood vessels (telangiectasias), and visceral changes such as swallowing problems, are absent. Nevertheless, the term remains used for diagnostic purposes.^{[citation needed]}

Signs and symptoms

Because the disease is rare and clinical presentations vary, a clear set of symptoms is difficult to define. Severe pain and swelling are often reported, and skin can resemble orange peel in appearance.^[7] Less common features include joint pain and carpal tunnel syndrome.^{[citation needed]}

Cause

Most cases are idiopathic, but strenuous exercise,^[6] initiation of hemodialysis,^[8] infection with Borrelia burgdorferi,^[9] and certain medications, such as statins, phenytoin, ramipril, and subcutaneous heparin,^[10] may trigger the condition.^[11]

Diagnosis

The key to diagnosis is the observation of skin changes in combination with eosinophilia, but the most accurate test is a biopsy of skin, fascia, and muscle.^{[citation needed]}

Treatment

Common treatments include corticosteroids^[12] such as prednisone, although medications such as hydroxychloroquine^[13] have also been used. Early initiation of treatment usually portends a good prognosis if there is no visceral involvement.^[7]^[14]

Epidemiology

Typical age of onset is around forty to fifty years, although cases in children have been observed. It remains unclear whether the condition is more common in women or men; patient numbers are small, and studies conflict in their reports of preponderance.^[15]

References

^ "Eosinophilic fasciitis: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 29 October 2019.
^ "Eosinophilic". Lexico UK English Dictionary. Oxford University Press. Archived from the original on 2020-03-22. "fasciitis". Oxford Dictionaries UK English Dictionary. Oxford University Press.^{[dead link]}
^ "Eosinophilic". Merriam-Webster.com Dictionary. Merriam-Webster. Retrieved 2016-01-21. "fasciitis". Merriam-Webster.com Dictionary. Merriam-Webster. Retrieved 2016-01-21.
^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.^{[page needed]}
^ Merck Manual, Professional Edition, Eosinophilic Fasciitis
^ ^a ^b Shulman, L. E (1975). "Diffuse fasciitis with eosinophilia: A new syndrome?". Transactions of the Association of American Physicians. 88: 70–86. PMID 1224441.
^ ^a ^b Bischoff, Lindsay; Chris T. Derk (January 2008). "Eosinophilic fasciitis: demographics, disease pattern and response to treatment: report of 12 cases and review of the literature". International Journal of Dermatology. 47 (1): 29–35. doi:10.1111/j.1365-4632.2007.03544.x. PMID 18173597. S2CID 25791443.
^ Florell, Scott R; Egan, Conleth A; Gregory, Martin C; Zone, John J; Petersen, Marta J (2016). "Eosinophilic Fasciitis Occurring Four Weeks after the Onset of Dialysis in a Renal Failure Patient". Journal of Cutaneous Medicine and Surgery. 5 (1): 33–6. doi:10.1177/120347540100500108. PMID 11281432. S2CID 208066832.
^ Mosconi, Sandro; Streit, Markus; Brönimann, Marcel; Braathen, Lasse R (2002). "Eosinophilic Fasciitis (Shulman Syndrome)". Dermatology. 205 (2): 204–6. doi:10.1159/000063916. PMID 12218249. S2CID 37435478.
^ Long, Hai; Zhang, Guiying; Wang, Ling; Lu, Qianjin (2015). "Eosinophilic Skin Diseases: A Comprehensive Review". Clinical Reviews in Allergy & Immunology. 50 (2): 189–213. doi:10.1007/s12016-015-8485-8. PMID 25876839. S2CID 30806009.
^ Pinal-Fernandez, I; Selva-O'Callaghan, A; Grau, J.M (2014). "Diagnosis and classification of eosinophilic fasciitis". Autoimmunity Reviews. 13 (4–5): 379–82. doi:10.1016/j.autrev.2014.01.019. PMID 24424187.
^ Antic M, Lautenschlager S, Itin PH (2006). "Eosinophilic fasciitis 30 years after - what do we really know? Report of 11 patients and review of the literature". Dermatology. 213 (2): 93–101. doi:10.1159/000093847. PMID 16902285. S2CID 29769383.
^ Lakhanpal S, Ginsburg WW, Michet CJ, Doyle JA, Moore SB (1988). "Eosinophilic fasciitis: clinical spectrum and therapeutic response in 52 cases". Semin. Arthritis Rheum. 17 (4): 221–31. doi:10.1016/0049-0172(88)90008-X. PMID 3232080.
^ Valadares, Diana; Joao Neves; Isabel Almeida; Carlos Lopes; Carlos Vasconcelos (February 2011). "Iron Lady: A Case of Eosinophilic Fasciitis". Journal of Medical Case Reports. 2: 34–36. doi:10.4021/jmc118w.
^ Wojas-Pelc, Anna; Wielowieyska-Szybińska, Dorota; Lipko-Godlewska, Sylwia (2004). "Eozynofilowe zapalenie powięzi - aktualny stan wiedzy" [Eosinophilic fasciitis--current database]. Polski Merkuriusz Lekarski (in Polish). 16 (96): 585–8. PMID 15510903.