In this VETgirl online veterinary continuing education blog, we discuss Well's syndrome in dogs. Never heard of it? Not sure what clinical signs or treatment are needed for Well's syndrome? Keep reading!
Is it really true? All's Well That Ends in Well's? So maybe that isn't the exact saying...but the question remains, what is Well's syndrome in Dogs?
Well's Syndrome was first named in 1971, when George Wells described this syndrome as a recurrent granulomatous dermatitis with eosinophilia. Wells syndrome, otherwise known as eosinophilic cellulitis, has an unknown etiology. In people, the presentation usually involves a mildly pruritic or tender cellulitis-like eruption with typical histologic features characterized by edema, flame figures, and a marked infiltrate of eosinophils in the dermis. Papular and nodular eruptions at the clinical presentation have also been reported. The condition can recur and may be preceded by a pruritic papular eruption. Although Wells syndrome is usually sporadic, some familial cases have been reported.
In dogs, a Well's-like syndrome has also been described. Commonly, it is associated with an eosinophilic dermatitis. It has been associated with gastrointestinal signs and the use of metronidazole. The question remains, was it part of the gastrointestinal illness where metronidazole was prescribed, OR, was it a result of the metronidazole used for the gastrointestinal signs?
Common canine skin lesions include papules, macules, and erythema. The patient may also be pruritic. Histopathology shows an eosinophilic dermatitis. Similar to the human findings, the pathologist will report 'flame figures' (collagen surrounded by eosinophils or their granules).
Treatment consists of:
- Discontinue the metronidazole if previously administered
- Corticosteroid therapy (e.g. prednisolone / prednisone) dosed at at 1–2 mg/kg by mouth every 12 hours, then tapered
- Treatment duration may vary based on severity, but 2-4 weeks is a common duration.
- Additional supportive care including fluid therapy, anti-emetics, and symptomatic supportive care, based on the specific patient characteristics.
When in doubt, consult your veterinary dermatologist and make sure to get a biopsy prior to treatment!
Dr. Garret Pachtinger, DACVECC
VETgirl Co-Founder and COO