Eosinophilic Fasciitis — SCE Dermatology MCQ

Correct answer: A — Oral Prednisolone 0.5-1 mg/kg/day

The correct answer is A, oral prednisolone 0.5 to 1 mg per kg per day. Eosinophilic fasciitis (Shulman syndrome) is a fibrosing disorder driven by an inflammatory eosinophilic infiltrate of the deep fascia, and systemic corticosteroids remain the treatment that most reliably suppresses this inflammation early, halting progression to fascial fibrosis and joint contractures. Treatment should start promptly once deep biopsy confirms fascial thickening with eosinophilic infiltrate, because the woody induration and peau d'orange changes described are potentially reversible if steroids are initiated before fibrosis becomes fixed. High-dose oral steroids are titrated against clinical response (softening of skin, resolving oedema) and inflammatory markers, then tapered slowly, with methotrexate commonly added as a steroid-sparing agent in refractory or relapsing disease. Why the other options are wrong: B. Physiotherapy alone: physiotherapy has an important adjunctive role in preventing and treating joint contractures, but used alone it does not address the underlying eosinophilic inflammation of the fascia and will not halt disease progression. D. Phototherapy: phototherapy has an established role in morphoea and localized scleroderma type skin fibrosis but is not first-line for eosinophilic fasciitis, which involves deep fascia beyond the reach of UV penetration. E. Oral Hydroxychloroquine: hydroxychloroquine is used in connective tissue diseases such as lupus and has no established first-line role in eosinophilic fasciitis, which responds far more predictably to corticosteroids. C. Topical corticosteroids: topical steroids act only on epidermis and superficial dermis and cannot penetrate to treat inflammation situated in the deep fascia, which is the pathological site in this disease. Key point: Eosinophilic fasciitis is treated with high-dose systemic (not topical) corticosteroids started early to prevent irreversible fascial fibrosis and contractures.

Reference: DermNet NZ, Eosinophilic Fasciitis, https://dermnetnz.org/topics/eosinophilic-fasciitis