Wells syndrome: clinical findings and management in a large cohort of 48 patients

Background and Objectives: Wells syndrome (WS) is a rare inflammatory skin disorder typically characterized by erythematous, edematous, and pruritic plaques. Despite its distinct histopathological features, WS remains an underdiagnosed disease due to its variable clinical presentations and overlap with other dermatological conditions. This study aims to provide a comprehensive overview of WS to enhance diagnostic and management.Patients and Methods: A retrospective analysis for the period 2018-2023 was conducted on 48 patients with WS at the Dermatology Unit of the University of Bologna, Italy. Data collected included demographics, clinical manifestations, hematological findings, histopathological characteristics, therapies, and outcomes. Descriptive statistics were used to analyze and summarize the data.Results: The mean onset age was 60.7 years, with 56% of patients having localized WS and 44% generalized WS. The most common subtype was urticaria-like WS (38%), followed by papulonodular, vesiculobullous, granuloma annulare-like, and cellulitis-like forms. First-line treatments included topical and systemic corticosteroids. In contrast, recurrence was observed in 29% of cases during the follow-up.Conclusions: WS is a heterogeneous underdiagnosed condition requiring clinical-histologic correlation for accurate diagnosis. Tailored therapeutic strategies are essential, particularly for generalized or refractory cases. Future research should explore the immunological mechanisms underlying WS and identify predictive factors for recurrence.