Eosinophilic fasciitis in Adult
Classically, EF presents with symmetrical edema and woody induration of the affected extremities but sparing the hands, feet, and face, which progresses rapidly to fibrosis, induration, and a peau d'orange appearance due to the depth and extent of inflammation and fibrosis. It is usually accompanied by pain and joint contractures resulting in a decreased range of motion and paresthesias. The skin in EF is often bound down, accentuating the natural planes between muscles and vasculature, and revealing linear depressions along superficial veins causing the groove sign.
The cause of the disease is currently unknown. EF affects both sexes, with women more commonly affected than men. Individuals of Northern European descent have been most often reported to suffer from EF. The disease has occurred in patients of all ages, from childhood to the elderly, but most patients are middle aged. A history of strenuous physical activity preceding the clinical findings of EF occurs in approximately 30% of patients. Some researchers have hypothesized that certain environmental exposures, including drugs, toxins, and infections (Borrelia burgdorferi), may be potential causes. In addition, thrombocytopenia, aplastic anemia, myelodysplastic syndromes, and other myeloproliferative disorders are associated with EF.
While some authorities believe that EF overlaps with deep morphea and scleroderma, features that distinguish EF are a peripheral eosinophilia (in 60%-80% of patients), hypergammaglobulinemia (in 20%-70% of patients), and an absence of Raynaud phenomenon that is common to systemic sclerosis. In a retrospective study, 21 of 60 patients (35%) had concurrent plaque morphea. Antinuclear antibody (ANA) titers are normal. Erythrocyte sedimentation rate (ESR) is usually elevated.
For more information, see OMIM.
M35.4 – Diffuse (eosinophilic) fasciitis
24129002 – Fasciitis with eosinophilia syndrome
- Scleroderma – A more superficial fibrotic connective tissue disease that is associated with Raynaud phenomenon and internal visceral involvement.
- Morphea – A form of cutaneously limited scleroderma characterized by isolated plaques of the skin; it is usually not as symmetrical, extensive, or abrupt as EF.
- Scleromyxedema – Presents with papules coalescing into indurated plaques on the extremities and is associated with paraproteinemia as well, but biopsy shows a hypercellular and myxedematous superficial fibrosis rather than a deep fibrosis of the fascia.
- Nephrogenic systemic fibrosis – Occurs in the setting of significant kidney disease and is highly associated with the administration of gadolinium-based contrast agents during periods of renal insufficiency.
- Eosinophilia-myalgia syndrome / toxic oil syndrome – In the 1980s and early 1990s, contaminated rapeseed oil and contaminated tryptophan supplements resulted in a disease presentation similar to EF that caused erythema, edema, fibrosis, and joint contractures, but the illnesses disappeared with identification of the contaminated ingestants.