title: Wells syndrome (eosinophilic cellulitis): Proposed diagnostic criteria and a literature review of the drug-induced variant.
abstract: BACKGROUND
  Wells syndrome is an uncommon inflammatory dermatosis first described in 1971 by Wells. The clinical eruption is characterized by varying morphology and severity and usually follows a relapsing remitting course. The majority of the reported cases are of unknown etiology, drug induced Wells syndrome has rarely been reported. A literature search using MEDLINE was performed. We recorded the features of our case and of the additional cases of drug induced Wells syndrome in the literature.
  
  
  METHODS
  Including our case there are 25 cases of drug-induced Wells syndrome reported. Causative drugs include antibiotics, anticholinergic agents, anaesthetics, non-steroidal anti-inflammatory agents, thyroid medications, chemotherapeutic agents, thiomersal containing vaccinations, anti-tumor necrosis factor agents and thiazide diuretics.
  
  
  CONCLUSIONS
  To the authors knowledge this is the first reported case of drug-induced Wells syndrome from thiazide diuretics. The diagnosis of Wells syndrome is often controversial and we propose a set of diagnostic criteria.
authors.affiliation: Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland; ; Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Canada.
authors.forename: Kara
authors.initials: K
authors.lastname: Heelan
authors.affiliation: Department of Histopathology, Our Lady of Lourdes Hospital, Drogheda, Ireland;
authors.forename: John F
authors.initials: JF
authors.lastname: Ryan
authors.affiliation: Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Canada.
authors.forename: Neil H
authors.initials: NH
authors.lastname: Shear
authors.affiliation: Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland;
authors.forename: Conleth A
authors.initials: CA
authors.lastname: Egan
keywords: aliskiren; antibiotics; diuretic; drug reaction; drug-induced; eosinophilia; etanercept; hydrochlorothiazide; hypertension; penicillin