Ann Dermatol.  2010 Feb;22(1):106-109. 10.5021/ad.2010.22.1.106.

A Case of Neutrophilic Dermatosis of the Dorsal Hands with Concomitant Involvement of the Lips

• Byun JW
• Hong WK
• Song HJ
• Han SH
• Lee HS
• Choi GS
• Shin JH

• KMID: 2172053
• DOI: http://doi.org/10.5021/ad.2010.22.1.106

Abstract

Neutrophilic dermatosis of the dorsal hands (NDDH) is a localized, pustular variant of acute febrile neutrophilic dermatosis (Sweet syndrome). The lesions of NDDH clinically resemble those of Sweet syndrome (SS), but they differ from classic SS according to their locations (NDDH is predominantly restricted to the dorsal hands) and the smaller number of accompanying systemic symptoms. The histology of the NDDH lesion shows a dense dermal neutrophilic infiltration. The lesions rapidly resolve after systemic corticosteroid and/or dapsone therapy. We herein report on a case of neutrophilic dermatosis of the dorsal hands in a 34-year-old woman. The patient also had skin changes with erythematous plaque on the right lips.

Keyword

Dorsal hand; Neutrophilic dermatosis; Sweet syndrome

MeSH Terms

Adult
Dapsone
Female
Hand
Humans
Lip
Neutrophils
Skin
Skin Diseases
Sweet Syndrome
Dapsone

Figure

• 

  Fig. 1 (A) Tender, erythematous, well-demarcated plaques on the dorsum of the right hand. (B) Erythematous plaque with small vesicles (arrow) on the right lips.

• 

  Fig. 2 The skin biopsy from the right hand shows prominent edema in the papillary dermis and a perivascular cellular infiltration that is mainly composed of neutrophils with no features of true vasculitis (A: H&E, ×40; B: H&E, ×200).

• 

  Fig. 3 The skin biopsy from the lips shows subepidermal separation and a perivascular and interstitial mixed-cell infiltrate composed of neutrophils and lymphocytes (A: H&E, ×40; B: H&E, ×200).

Reference

1. Neoh CY, Tan AW, Ng SK. Sweet's syndrome: a spectrum of unusual clinical presentations and associations. Br J Dermatol. 2007. 156:480–485.

2. Del Pozo J, Sacristan F, Martinez W, Paradela S, Fernandez-Jorge B, Fonseca E. Neutrophilic dermatosis of the hands: presentation of eight cases and review of the literature. J Dermatol. 2007. 34:243–247.

3. Galaria NA, Junkins-Hopkins JM, Kligman D, James WD. Neutrophilic dermatosis of the dorsal hands: pustular vasculitis revisited. J Am Acad Dermatol. 2000. 43:870–874.

4. Cohen PR, Honigsmann H, Kurzrock R. Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Acute febrile neutrophilic dermatosis (Sweet syndrome). Fitzpatrick's dermatology in general medicine. 2008. 7th ed. New York: McGraw-Hill;289–295.

5. Strutton G, Weedon D, Robertson I. Pustular vasculitis of the hands. J Am Acad Dermatol. 1995. 32:192–198.

6. Gilaberte Y, Coscojuela C, Garcia-Prats MD. Neutrophilic dermatosis of the dorsal hands versus pustular vasculitis. J Am Acad Dermatol. 2002. 46:962–963.

7. Walling HW, Snipes CJ, Gerami P, Piette WW. The relationship between neutrophilic dermatosis of the dorsal hands and sweet syndrome: report of 9 cases and comparison to atypical pyoderma gangrenosum. Arch Dermatol. 2006. 142:57–63.

8. Cohen DE, Jacob SE. Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Allergic contact dermatitis. Fitzpatrick's dermatology in general medicine. 2008. 7th ed. New York: McGraw-Hill;135–146.

9. Kung EF, Arora A, Petronic-Rosic V, Tsoukas MM. Clinicopathologic challenge. Neutrophilic dermatosis of the dorsal hands--a variant of localized Sweet's syndrome. Int J Dermatol. 2009. 48:555–557.

10. Bourke JF, Keohane S, Long CC, Kemmett D, Davies M, Zaki I, et al. Sweet's syndrome and malignancy in the U.K. Br J Dermatol. 1997. 137:609–613.

11. Kim HH, Lee DP, Suh HS, Lee MW, Choi JH, Moon KC, et al. A case of neutrophilic dermatosis of the dorsal hands. Korean J Dermatol. 2003. 41:1351–1353.