Abstract:

Neutrophilic dermatosis of the dorsal hands (NDDH) is considered a localized variant of Sweet Syndrome. We present a 55-year-old woman with a one-day history of non-tender, pink papules on the dorsum of the hands bilaterally. The patient had a similar episode seven years prior that progressed to tender, draining, hemorrhagic-appearing bullous lesions that were treated with intramuscular steroid and resolved over a few weeks. She had no systemic symptoms associated with the papules. Her underlying conditions were significant for diabetes mellitus, hypertension, chronic kidney disease, and autoimmune polyradiculitis. There were no known triggers such as trauma or exposure to exogenous agents. Her labs were unremarkable except for slight leukocytosis and mild anemia. Histologic examination revealed neutrophilic infiltrate and mild edema within the papillary dermis. Leukocytoclasia and focal red cell extravasation were noted, but there was no evidence of vasculitis. Infection was excluded and there was no evidence of hematological malignancies or solid tumors. The constellation of findings was consistent with NDDH. Our patient’s lesions resolved without treatment over three weeks. In this report, we aim to raise awareness of this under-recognized entity and review histological differential diagnosis. NDDH has an excellent course and it is important that dermatopathologists and dermatologists are aware of this entity to avoid misdiagnosis and unnecessary or aggressive treatments.

Financial Disclosure:
No current or relevant financial relationships exist.

Menu

Alexandria Wellman, MD, MS