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Case Reports

Abstract

Neutrophilic dermatosis of dorsal hands (NDDH) is a rare inflammatory skin condition characterized by painful, sterile pustules and plaques primarily on the dorsal hands, representing a variant of Sweet's syndrome. We report a case of a 75-year-old female presenting with longstanding blackened areas on bilateral dorsal hands. The lesions, initially suspected to be bite marks due to their annular appearance, worsened despite debridement and treatment with doxycycline and xeroform. They evolved into erythematous, violaceous bullae with ulceration, accompanied by severe pain. Furthermore, the patient has a complex medical history, including hydronephrosis status post nephrostomy, recurrent urinary tract infections, chronic obstructive pulmonary disease, hypertension, severe peripheral artery disease, and a history of a right psoas abscess secondary to intravenous drug use. Histologically, sections showed a brisk neutrophilic dermal infiltrate with focal fibrinoid necrosis and leukocytoclastic debris without definite vascular degeneration. Special stains and wound cultures were negative for microorganisms. In the setting of a negative infectious workup, the histologic features were supportive of the clinical differential diagnosis of neutrophilic dermatosis of the dorsal hands. Despite initial treatment with topical steroids, lesion progression necessitated systemic therapy with oral prednisone. Screening for underlying systemic disorders, including hematologic malignancies and solid tumors, was recommended. This case emphasizes the need for heightened awareness among dermatologists and dermatopathologists regarding NDDH. Early biopsy and accurate diagnosis are crucial to prevent mismanagement, guide appropriate therapeutic decisions, and screen for potential underlying causes, thereby enhancing patient outcomes in this lesser-known condition.