Subcorneal pustular dermatosis masquerading as eczematous dermatitis: a case report and mechanistic review

Authors

Peter Dimitrion, Henry Ford HealthFollow
Maria L. Espinosa, Henry Ford HealthFollow
Jesse Veenstra, Henry Ford HealthFollow

Recommended Citation

Dimitrion P, Espinosa ML, and Veenstra J. Subcorneal pustular dermatosis masquerading as eczematous dermatitis: a case report and mechanistic review. BMJ Case Rep 2025;18(7).

Document Type

Article

Publication Date

7-31-2025

Publication Title

BMJ Case Rep

Abstract

This case describes a woman with a decades-long history of misdiagnosed eczematous dermatitis ultimately identified as subcorneal pustular dermatosis (SPD), a rare neutrophilic dermatosis. Initially treated unsuccessfully for presumed atopic dermatitis and prurigo nodularis with various immunomodulatory agents, including dupilumab and Janus kinase (JAK) inhibitors, the correct diagnosis was made only after the appearance of characteristic flaccid pustules in intertriginous areas. Histopathological analysis confirmed SPD, and following intolerance to initial treatment with dapsone, the patient experienced a dramatic and sustained clinical improvement with infliximab. This case highlights the diagnostic challenges posed by atypical presentations of SPD and supports the use of tumour necrosis factor-alpha (TNFα) inhibitors as a highly effective treatment option.

Medical Subject Headings

Humans; Dapsone; Diagnosis, Differential; Eczema; Infliximab; Skin Diseases, Vesiculobullous

PubMed ID

40744633

Volume

18

Issue

7