Abstract
Neutrophilic dermatoses encompass a group of skin disorders characterized by sterile cutaneous neutrophilic infiltrate. Multiple distinct entities have been recognized. Coexistence of two or three of these disorders has been documented. We are describing a patient who presented with five entities that could fall under the neutrophilic dermatoses category. The patient is a 45-year-old white female with obesity, diabetes mellitus, and irritable bowel syndrome. She presented with pyoderma gangrenosum of lower extremities, hidradenitis suppurativa of axillae and vulva, psoriasis involving back and scalp and psoriatic arthritis, perforating collagenosis of lower extremities, erythema elevatum diutinum on the feet, and a history of cutaneous leukocytoclastic vasculitis. She also had a history of lipodermatosclerosis and carbuncles. The course of her dermatoses has been chronic, waxing and waning. These dermatoses share features of idiopathic cutaneous neutrophil infiltrate. For perforating folliculitis and perforating collagenosis, focal neutrophil aggregates at the perforating sites are characteristic. A neutrophilic infiltrate, therefore, may play a role in the perforation of the epithelium, like in Behcet’s disease and pyoderma gangrenosum. Leukocytoclastic vasculitis shows variable neutrophil infiltrate. It is not uncommon to see leukocytoclastic vasculitis with extended cutaneous neutrophilic dermatosis, such as urticarial vasculitis, leukocytoclastic vasculitis with diffuse dermal infiltrate of neutrophils, such as ones seen in erythema elevatum diutinum, and in pustular leukocytoclastic vasculitis. A heightened neutrophil activation pathway may be the shared pathogenesis for the above-mentioned neutrophilic dermatoses.