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Editorial |

Reflections on Eosinophils and Flame Figures:  Where There's Smoke There's Not Necessarily Wells Syndrome

Kristin M. Leiferman, MD; Margot S. Peters, MD
Arch Dermatol. 2006;142(9):1215-1218. doi:10.1001/archderm.142.9.1215.
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Eosinophils were first described in 1879 by Paul Ehrlich, who recognized their ability to stain with acid dyes, particularly eosin. The distinctive tinctorial properties of eosinophil granules give these cells a prominence in stained sections that contrasts with their lack of diagnostic power and still undefined role in pathogenesis. Eosinophils may be seen in skin biopsy specimens from patients with various inflammatory and neoplastic disorders, but they are among the diagnostic criteria in a limited number of diseases, including Wells syndrome, angiolymphoid hyperplasia with eosinophilia, and eosinophilic pustulosis.1,2

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Figure.

Eosinophil granule major basic protein immunostaining in urticaria: evidence for extensive granule protein deposition with few intact cells in an edematous reaction. A, Major basic protein staining in a urticarial lesion shows few intact perivascular cells (brightly staining ovals) and extensive extracellular major basic protein staining throughout the dermis, noted as distinct granules and confluent areas of deposition on connective tissue (original magnification ×160). B, Hematoxylin-eosin counterstaining of tissue section in A shows 1:1 correlation of intact cells, but the extensive extracellular major basic protein deposition is not visible (original magnification ×160).

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